LIVRE JDG 2012

Physeal-sparing MPFL reconstruction in children

collateral ligament as a pulley as described by

Deie [2] (fig. 2E). The three different layers of

the medial patellar system were dissected: the

first corresponds to the superficial retinaculum,

the second to the MPFL and MCL and the third

to the knee capsule. The tendon bundles were

transferred from the pulley to the patella

locating in the second layer taking care they

were not twisting each other.

Through the patella approach, two transversal

bone tunnels are drilled with the size of the

semitendinosus tendon (fig. 2C). Each graft

bundle is passed through the patella tunnels

[1]. After the graft is passed in the tunnels

(fig. 2F), it is passed back and sutured to itself

pulling the patella medially. Tensionning the

graft is performed with the knee in 30° of

flexion. The correct among of tension prevents

lateral subluxation without causing medial

subluxation or excessive medial compression.

Patella tracking and stability are tested throught

the range of knee motion. In full extension, the

patella slightly moves medially (favorable non

isometry).

Selected associated procedures are performed

during the same time

(Cf. global strategy)

The tourniquet is deflated and after accurate

hemostasis, an intra-articular drainage is or no

associated. The wounds are closed with

interrupted

subcutaneous

sutures

and

absorbable running subcuticular sutures. Elastic

bandagewrapandpostoperative immobilization

amovible brace with 10° flexion are used.

Postoperative care: full weight-bearing is

allowed immediately. Early active range of

motion exercices are started as tolerated.

Immediate continuous passive motion is

associated. A return to sport and full activities

is allowed after 4 to 6 months.

Method

Results were assessing with Kujala scoring

system. Objective correction of the patella tilt

was measured with CT scan preoperatively and

postoperatively 1 year following surgery.

Fig. 2: Details and intraoperative views of different steps for MPFL reconstruction in our unit.