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Introduction
There is a very high rate of recurrent instability
after primary acute patellar dislocation in
children with or without early repair medial
structures [13]. More than 100 procedures
reported for patella stabilization… This fact
presumes that no single technique is superior
for this multifaceted condition. More recently,
some authors highlighted the anatomy of
mediopatello femoral ligament and described
anatomic reconstruction of this structure [5, 14,
15]. Since 2000, there is growing interest in
exchanging themyriad of nonanatomic extensor
mechanism reconstructions for more anatomic
procedures based on restitution of the MPFL in
adults [1].
Few data are available about MPFL recons
truction in children since the first experience
published [2], except some recent and short
series [7, 12, 17]. The aim of this study was to
report our experiencewithMPFLreconstruction
in children and to describe our evolution toward
a personal and new procedure for MPFL
reconstruction on skeletally immature patients
and adolescents.
Patients and method
Indication
Great majority of permanent and habitual
dislocations have to be surgically corrected as
soon as possible. Stabilization is indicated in
case of episodic dislocation after major
objective patella instability with 2 or more
patella dislocations, trochlear dysplasia and
apprehension test +.
Our global strategy
Except MPFL reconstruction which is
systematically part of the treatment, patella
stabilisation surgery in our unit is a “à la carte
surgery” [4]. We are concerned about patella
alta and this condition should be treated during
the same time but anteriorly to the MPFL
reconstruction in order to keep a satisfied graft
isometry. Lateral release is performed “on
demand” only when lateral retinaculum is very
tight. For skeletally immature patient soft tibial
tubercule transfer according to Grammont is
associated when the Q angle was important or
Physeal-sparing MPFL
reconstruction in children:
experience of the pediatric orthopaedic
department of Lyon
F. Chotel, A. Peltier, A. Viste,
M.M. Chaker, J. Bérard