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Physeal-sparing MPFL reconstruction in children
51
Preliminary results with our new
physeal-sparing method
These are, for part, included in the prospective
study of symposium SFA 2012. In the overall
series, there was no recurrence of dislocation
after surgery. Radiological assessment showed
that the congruence angle, the tilt angle and the
lateral shift radio were restored to normal.
More detailed results will be presented during
the meeting.
Discussion
The exact relation of MPFL and the distal
femoral physis is still controversial; some
authors find it proximal and others distal to the
physis [10, 16]. Anatomic femoral insertion is
probably very close to the growth plate and
reconstruction should avoid femoral tunnel that
could generate growth disturbance. The
importance of an anatomically positioned
MPFL reconstruction has been highlighted as
non-anatomic attachments caused significant
loss of isometry.
Physeal-sparing technique of MPFL recons
truction using the posterior one-third of the
femoral insertion of the medial collateral
ligament as a pulley, have been described by
Deie in 2003 [2]. But in his technique the
semitendinosus was still attached distally on
the tibia and the reconstruction did use a single
bundle. We believe that a single bundle offer
low resistance in an adolescent knee and is less
anatomic than a double bundle. In mid-2010,
we started to detach the semitendinosus distally
keeping the principle of the pulley, and now
this procedure is used whatever is the skeletal
maturity.
Conclusion
Anatomic MPFL reconstruction is possible in
children and adolescent. In preliminary study,
the patellar tilt could be efficiently improved
by MPFL reconstruction and these results
correlated with Kujala score. Middle and long
term results still have to be evaluated.
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