Download PDF
CC BY-NC-ND 4.0 · Joints 2019; 07(03): 098-106
DOI: 10.1055/s-0039-3400451
Review Article

Medial Patellofemoral Ligament Reconstruction and Nonanatomic Stabilization Techniques in Skeletally Immature Patients

Carola Pilone
1   Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Torino, Italy
,
Davide Edoardo Bonasia
1   Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Torino, Italy
,
Federica Rosso
1   Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Torino, Italy
,
Umberto Cottino
1   Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Torino, Italy
,
Claudio Mazzola
2   SC Ortopedia Delle Articolazioni, Ospedali Galliera Genova, Genoa, Italy
,
Davide Blonna
1   Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Torino, Italy
,
Roberto Rossi
1   Department of Orthopaedics and Traumatology, AO Ordine Mauriziano Hospital, University of Torino, Torino, Italy
,
Sigascot Knee Committee › Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Patellar instability is a common cause of knee disability in children and adolescent, with a high recurrence rate. When conservative treatment fails, surgical options should be considered. The femoral insertion of the medial patellofemoral ligament (MPFL) is in close proximity to the distal femoral growth plate and precautions should be taken to avoid injuries to the physis. Anatomical features of the MPFL complex, with focus on the relationship between femoral MPFL attachment and femoral physis, are discussed together with surgical tips to avoid injuries to the growth plates. The aim of this article is to review the recent literature regarding MPFL reconstruction and other stabilization techniques for patellofemoral instability in skeletally immature patients, focusing on the different surgical options available. These can be classified as anatomical versus nonanatomical, proximal versus distal realignments, or based on the graft used: free graft and pedicled graft (quadriceps, patellar tendon, hamstring, and adductor magnus).

Keywords

medial patellofemoral ligament - children - adolescent - MPFL - patellar instability


Publication History

Received: 12 January 2018

Accepted: 15 October 2019

Article published online:
13 December 2019

© 2019. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Stuttgart · New York

 

  • References

  • 1 Vavken P, Wimmer MD, Camathias C, Quidde J, Valderrabano V, Pagenstert G. Treating patella instability in skeletally immature patients. Arthroscopy 2013; 29 (08) 1410-1422
    CrossrefPubMedGoogle Scholar
  • 2 Khormaee S, Kramer DE, Yen YM, Heyworth BE. Evaluation and management of patellar instability in pediatric and adolescent athletes. Sports Health 2015; 7 (02) 115-123
    CrossrefPubMedGoogle Scholar
  • 3 Weeks III KD, Fabricant PD, Ladenhauf HN, Green DW. Surgical options for patellar stabilization in the skeletally immature patient. Sports Med Arthrosc Rev 2012; 20 (03) 194-202
    CrossrefPubMedGoogle Scholar
  • 4 Beaufils P, Thaunat M, Pujol N, Scheffler S, Rossi R, Carmont M. Trochleoplasty in major trochlear dysplasia: current concepts. Sports Med Arthrosc Rehabil Ther Technol 2012; 4: 7
    CrossrefPubMedGoogle Scholar
  • 5 Hensler D, Sillanpaa PJ, Schoettle PB. Medial patellofemoral ligament: anatomy, injury and treatment in the adolescent knee. Curr Opin Pediatr 2014; 26 (01) 70-78
    CrossrefPubMedGoogle Scholar
  • 6 Warren LF, Marshall JL. The supporting structures and layers on the medial side of the knee: an anatomical analysis. J Bone Joint Surg Am 1979; 61 (01) 56-62
    CrossrefPubMedGoogle Scholar
  • 7 Alaia MJ, Cohn RM, Strauss EJ. Patellar instability. Bull Hosp Jt Dis (2013) 2014; 72 (01) 6-17
    PubMedGoogle Scholar
  • 8 LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L. The anatomy of the medial part of the knee. J Bone Joint Surg Am 2007; 89 (09) 2000-2010
    CrossrefPubMedGoogle Scholar
  • 9 Schottle PB, Romero J, Schmeling A, Weiler A. Technical note: anatomical reconstruction of the medial patellofemoral ligament using a free gracilis autograft. Arch Orthop Trauma Surg 2008; 128 (05) 479-484
    CrossrefPubMedGoogle Scholar
  • 10 Nelitz M, Dornacher D, Dreyhaupt J, Reichel H, Lippacher S. The relation of the distal femoral physis and the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 2011; 19 (12) 2067-2071
    CrossrefPubMedGoogle Scholar
  • 11 Shea KG, Grimm NL, Belzer J, Burks RT, Pfeiffer R. The relation of the femoral physis and the medial patellofemoral ligament. Arthroscopy 2010; 26 (08) 1083-1087
    CrossrefPubMedGoogle Scholar
  • 12 Farrow LD, Alentado VJ, Abdulnabi Z, Gilmore A, Liu RW. The relationship of the medial patellofemoral ligament attachment to the distal femoral physis. Am J Sports Med 2014; 42 (09) 2214-2218
    CrossrefPubMedGoogle Scholar
  • 13 Nguyen CV, Farrow LD, Liu RW, Gilmore A. Safe drilling paths in the distal femoral epiphysis for pediatric medial patellofemoral ligament reconstruction. Am J Sports Med 2017; 45 (05) 1085-1089
    CrossrefPubMedGoogle Scholar
  • 14 Kepler CK, Bogner EA, Hammoud S, Malcolmson G, Potter HG, Green DW. Zone of injury of the medial patellofemoral ligament after acute patellar dislocation in children and adolescents. Am J Sports Med 2011; 39 (07) 1444-1449
    CrossrefPubMedGoogle Scholar
  • 15 Lewallen LW, McIntosh AL, Dahm DL. Predictors of recurrent instability after acute patellofemoral dislocation in pediatric and adolescent patients. Am J Sports Med 2013; 41 (03) 575-581
    CrossrefPubMedGoogle Scholar
  • 16 Nwachukwu BU, So C, Schairer WW, Green DW, Dodwell ER. Surgical versus conservative management of acute patellar dislocation in children and adolescents: a systematic review. Knee Surg Sports Traumatol Arthrosc 2016; 24 (03) 760-767
    CrossrefPubMedGoogle Scholar
  • 17 Hohn E, Pandya NK. Does the utilization of allograft tissue in medial patellofemoral ligament reconstruction in pediatric and adolescent patients restore patellar stability?. Clin Orthop Relat Res 2017; 475 (06) 1563-1569
    CrossrefPubMedGoogle Scholar
  • 18 Nelitz M, Reichel H, Dornacher D, Lippacher S. Anatomical reconstruction of the medial patellofemoral ligament in children with open growth-plates. Arch Orthop Trauma Surg 2012; 132 (11) 1647-1651
    CrossrefPubMedGoogle Scholar
  • 19 Ladenhauf HN, Berkes MB, Green DW. Medial patellofemoral ligament reconstruction using hamstring autograft in children and adolescents. Arthrosc Tech 2013; 2 (02) e151-e154
    CrossrefPubMedGoogle Scholar
  • 20 Shafizadeh S, Balke M. Medial patellofemoral ligament reconstruction: a new technique for graft fixation at the patella without implants. Arthrosc Tech 2014; 3 (01) e115-e117
    CrossrefPubMedGoogle Scholar
  • 21 Sadigursky D, de Melo Laranjeira MS, Nunes M, Caneiro RJ, Colavolpe PO. Reconstruction of the medial patellofemoral ligament by means of the anatomical double-bundle technique using metal anchors. Rev Bras Ortop 2016; 51 (03) 290-297
    PubMedGoogle Scholar
  • 22 Kumahashi N, Kuwata S, Tadenuma T, Kadowaki M, Uchio Y. A “sandwich” method of reconstruction of the medial patellofemoral ligament using a titanium interference screw for patellar instability in skeletally immature patients. Arch Orthop Trauma Surg 2012; 132 (08) 1077-1083
    CrossrefPubMedGoogle Scholar
  • 23 Yercan HS, Erkan S, Okcu G, Ozalp RT. A novel technique for reconstruction of the medial patellofemoral ligament in skeletally immature patients. Arch Orthop Trauma Surg 2011; 131 (08) 1059-1065
    CrossrefPubMedGoogle Scholar
  • 24 Gomes JE. Comparison between a static and a dynamic technique for medial patellofemoral ligament reconstruction. Arthroscopy 2008; 24 (04) 430-435
    CrossrefPubMedGoogle Scholar
  • 25 Lind M, Enderlein D, Nielsen T, Christiansen SE, Faunø P. Clinical outcome after reconstruction of the medial patellofemoral ligament in paediatric patients with recurrent patella instability. Knee Surg Sports Traumatol Arthrosc 2016; 24 (03) 666-671
    CrossrefPubMedGoogle Scholar
  • 26 Fink C, Veselko M, Herbort M, Hoser C. Minimally invasive reconstruction of the medial patellofemoral ligament using quadriceps tendon. Arthrosc Tech 2014; 3 (03) e325-e329
    CrossrefPubMedGoogle Scholar
  • 27 Abouelsoud MM, Abdelhady A, Elshazly O. Anatomic physeal-sparing technique for medial patellofemoral ligament reconstruction in skeletally immature patients with ligamentous laxity. Eur J Orthop Surg Traumatol 2015; 25 (05) 921-926
    CrossrefPubMedGoogle Scholar
  • 28 Nelitz M, Dreyhaupt J, Williams SRM. Anatomic reconstruction of the medial patellofemoral ligament in children and adolescents using a pedicled quadriceps tendon graft shows favourable results at a minimum of 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 2018; 26 (04) 1210-1215
    PubMedGoogle Scholar
  • 29 Nelitz M, Williams SRM. Anatomic reconstruction of the medial patellofemoral ligament in children and adolescents using a pedicled quadriceps tendon graft. Arthrosc Tech 2014; 3 (02) e303-e308
    CrossrefPubMedGoogle Scholar
  • 30 Galeazzi R. Nuove applicazioni del trapianto muscolare e tendineo. Arch Di Ortop Milano 1922; 38: 315-323
    PubMedGoogle Scholar
  • 31 Nietosvaara Y, Paukku R, Palmu S, Donell ST. Acute patellar dislocation in children and adolescents. Surgical technique. J Bone Joint Surg Am 2009; 91 (Suppl 2 Pt 1): 139-145
    CrossrefPubMedGoogle Scholar
  • 32 Giordano M, Falciglia F, Aulisa AG, Guzzanti V. Patellar dislocation in skeletally immature patients: semitendinosous and gracilis augmentation for combined medial patellofemoral and medial patellotibial ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2012; 20 (08) 1594-1598
    CrossrefPubMedGoogle Scholar
  • 33 Sadigursky D, Garcia LC, Armede M, Oliveira LR, Carneiro RJF, Colavolpe PO. Medial patellofemoral ligament and medial patellotibial ligament reconstruction in children: preliminary results. Rev Bras Ortop 2017; 52 (04) 417-422
    CrossrefPubMedGoogle Scholar
  • 34 Alm L, Krause M, Mull C, Frosch KH, Akoto R. Modified adductor sling technique: a surgical therapy for patellar instability in skeletally immature patients. Knee 2017; 24 (06) 1282-1288
    CrossrefPubMedGoogle Scholar
  • 35 Deie M, Ochi M, Sumen Y, Yasumoto M, Kobayashi K, Kimura H. Reconstruction of the medial patellofemoral ligament for the treatment of habitual or recurrent dislocation of the patella in children. J Bone Joint Surg Br 2003; 85 (06) 887-890
    CrossrefPubMedGoogle Scholar
  • 36 Hinckel BB, Gobbi RG, Demange MK, Bonadio MB, Pécora JR, Camanho GL. Combined reconstruction of the medial patellofemoral ligament with quadricipital tendon and medial patellotibial ligament with patellar tendon. Arthrosc Tech 2016; 5 (01) e79-e84
    CrossrefPubMedGoogle Scholar
  • 37 Avikainen VJ, Nikku RK, Seppänen-Lehmonen TK. Adductor magnus tenodesis for patellar dislocation. Technique and preliminary results. Clin Orthop Relat Res 1993; (297) 12-16
    PubMedGoogle Scholar
  • 38 Malecki K, Fabis J, Flont P, Lipczyk Z, Niedzielski K. Preliminary results of two surgical techniques in the treatment of recurrent patellar dislocation: medial patellofemoral ligament reconstruction versus combined technique of vastus medialis advancement, capsular plasty and Roux-Goldthwait procedure in treatment of recurrent patellar dislocation. Int Orthop 2016; 40 (09) 1869-1874
    CrossrefPubMedGoogle Scholar
  • 39 Steiner TM, Torga-Spak R, Teitge RA. Medial patellofemoral ligament reconstruction in patients with lateral patellar instability and trochlear dysplasia. Am J Sports Med 2006; 34 (08) 1254-1261
    CrossrefPubMedGoogle Scholar
  • 40 Roux C. Recurrent dislocation of the patella: operative treatment. 1888. Clin Orthop Relat Res 2006; 452 (452) 17-20
    CrossrefPubMedGoogle Scholar
  • 41 Goldthwait JE. Dislocation of the patella. Trans Am Orthop Assoc 1895; 8: 237-238
    PubMedGoogle Scholar
  • 42 Luhmann SJ, O'Donnell JC, Fuhrhop S. Outcomes after patellar realignment surgery for recurrent patellar instability dislocations: a minimum 3-year follow-up study of children and adolescents. J Pediatr Orthop 2011; 31 (01) 65-71
    CrossrefPubMedGoogle Scholar
  • 43 Bitar AC, Demange MK, D'Elia CO, Camanho GL. Traumatic patellar dislocation: nonoperative treatment compared with MPFL reconstruction using patellar tendon. Am J Sports Med 2012; 40 (01) 114-122
    CrossrefPubMedGoogle Scholar
  • 44 Parikh SN, Nathan ST, Wall EJ, Eismann EA. Complications of medial patellofemoral ligament reconstruction in young patients. Am J Sports Med 2013; 41 (05) 1030-1038
    CrossrefPubMedGoogle Scholar
  • 45 Bollier M, Fulkerson J, Cosgarea A, Tanaka M. Technical failure of medial patellofemoral ligament reconstruction. Arthroscopy 2011; 27 (08) 1153-1159
    CrossrefPubMedGoogle Scholar
  • 46 Schneider DK, Grawe B, Magnussen RA. et al. Outcomes after isolated medial patellofemoral ligament reconstruction for the treatment of recurrent lateral patellar dislocations: a systematic review and meta-analysis. Am J Sports Med 2016; 44 (11) 2993-3005
    CrossrefPubMedGoogle Scholar
  • 47 Seitlinger G, Moroder P, Fink C, Wierer G. Acquired femoral flexion deformity due to physeal injury during medial patellofemoral ligament reconstruction. Knee 2017; 24 (03) 680-685
    CrossrefPubMedGoogle Scholar
  • 48 Hasler CC, Studer D. Patella instability in children and adolescents. EFORT Open Rev 2017; 1 (05) 160-166
    CrossrefPubMedGoogle Scholar