Background: The medial patello-femoral ligament (MPFL) is a major patellar stabiliser whose reconstruction in adults involves graft fixation within a femoral tunnel. In skeletally immature patients, in contrast, the graft is fixed to the soft tissues to allow normal growth. The primary objective of this prospective study was to perform computed tomography (CT) and magnetic resonance imaging (MRI) assessments of medium-term correction of patellar tilt and of the axial patellar engagement index (AEI) after a paediatric variant of MPFL reconstruction in skeletally immature patients.
Hypothesis: MPFL reconstruction, performed alone or combined with other procedures in skeletally immature patients, decreases patellar tilt and improves the AEI.
Material And Methods: Eighteen children and adolescents with a median age of 14.6 years (range, 8-17 years) who underwent MPFL reconstruction on 20 knees were included in this prospective observational study. A double-strand gracilis tendon graft passed through the medial collateral ligament was used. MPFL reconstruction was performed alone in 13 knees and was combined with lateral retinaculum release, tibial tuberosity translation, and/or trochleoplasty in 7 knees. Patellar tilt and AEI values determined on preoperative and post-operative imaging studies with the quadriceps relaxed and contracted were compared. A physical examination was also performed.
Results: From baseline to last follow-up after a mean of 43 months (range, 24-63 months), patellar tilt decreased from 20° preoperatively to 9° with the quadriceps relaxed and from 33° to 15.4° with the quadriceps contracted. The AEI increased from 0.78 at baseline to 0.93 at last follow-up. No dislocation or subluxation recurrences were recorded during follow-up.
Discussion: The patellar tilt and AEI improvements seen after paediatric MPFL reconstruction confirm the study hypothesis. This is the first prospective study of patellar position in the axial plane as assessed by CT and MRI after paediatric MPFL reconstruction. In everyday clinical practice, 3D assessments of patellar tilt and the AEI should be performed to evaluate correction of the abnormalities.
Level Of Evidence: II, non-randomised prospective observational study.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.otsr.2018.10.002 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Intraoperative Patellofemoral Kinematic Acquisition: The Design, Testing, and Validation of a Setup for Clinical Studies.
J Clin Med
December 2024
IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy.
: Abnormalities in patellar tracking, often overlooked in surgical planning, have been identified as a contributing factor to total knee arthroplasty (TKA) complications, including anterior knee pain, patellar subluxation, and dislocation. This study aims to evaluate the repeatability of a novel intraoperative setup for assessing patellofemoral kinematics and its interaction with prosthesis design and positioning during surgery. This setup may support personalized alignment techniques in TKA, potentially improving surgical outcomes.
View Article and Find Full Text PDFPatellar Non-Traumatic Pathologies: A Pictorial Review of Radiologic Findings.
Diagnostics (Basel)
December 2024
Department of Radiology, Division of Musculoskeletal Imaging and Intervention, University of Washington, Seattle, WA 98105, USA.
Patellar pathologies are a common cause of knee dysfunction, with Patellofemoral Pain Syndrome (PFPS) alone responsible for 25% of knee-related visits to sports medicine clinics. Non-traumatic conditions, while often overlooked, can also lead to significant discomfort and functional limitations, highlighting the importance of accurate and timely diagnosis for effective management and prevention of complications. This pictorial review examines the radiologic characteristics of various non-traumatic patellar disorders, focusing on imaging modalities such as radiography, computed tomography (CT), and magnetic resonance imaging (MRI).
View Article and Find Full Text PDFNavigating medial patellotibial ligament reconstruction: Clinical perspectives and surgical strategies.
World J Clin Cases
January 2025
Division of Knee, Hospital Italiano de Buenos Aires, Buenos Aires 1109, Argentina.
The surgical approach for patellar instability usually refers to reconstruction of the medial patellofemoral ligament associated with an osteotomy of the tibial tuberosity or a trochleoplasty when required. The medial patellotibial ligament and the medial patellomeniscal ligament are secondary stabilizers of the patella. Despite this, both the medial patellotibial and patellofemoral ligaments aid in patellar rotation and tilt when the knee is flexed beyond 45°.
View Article and Find Full Text PDFAnalysis of spatial patellofemoral alignment using novel three-dimensional measurements based on weight-bearing cone-beam CT.
Insights Imaging
January 2025
Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Objectives: To propose a reliable and standard 3D assessment method to analyze the effect of weight-bearing (WB) status on the location of patella and clarify the diagnostic performance of 3D parameters for recurrent patellar dislocation (RPD) in WB and non-weight-bearing (NWB) conditions.
Methods: Sixty-five knees of RPD patients and 99 knees of controls were included. Eight landmarks, two lines and a coordinate system were defined on 3D bone models of knees based on weight-bearing CT and non-weight-bearing CT.
Morphological Improvement of the Epiphyseal Plate and Trochlea After Surgical Correction in Skeletally Immature Patients With Patellar Dislocation and Trochlear Dysplasia.
Am J Sports Med
January 2025
Department of Orthopaedic Surgery, Hebei Medical University Third Hospital, Shijiazhuang, China.
Background: Studies have revealed abnormalities of the epiphyseal plate of the distal femur in patients with trochlear dysplasia, but it is unclear whether the epiphyseal plate could be remodeled after surgical correction of patellar dislocation.
Purpose: To investigate whether the morphology of the epiphyseal plate and trochlea could be improved after medial patellar retinaculum plasty in skeletally immature patients and to investigate the correlations between the morphology of the epiphyseal plate and trochlear dysplasia as well as clinical outcomes.
Study Design: Cohort study; Level of evidence, 3.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!