Summary

Physeal-sparing MPFL reconstruction in children and adolescents yields excellent midterm results and allows patients to return to sports without redislocation of the patella.

Abstract

Background

Patellar dislocation is a prevalent orthopedic issue among pediatric and adolescent populations. Conventional treatment options are often suboptimal for skeletally immature individuals. This retrospective study aims to clarify the outcomes of MPFL reconstruction in skeletally immature patients with open physis.

Methods

Twenty-four consecutive patients with patellofemoral instability and open growth plates underwent anatomic MPFL reconstruction with a physeal-sparing technique. All subjects have had more than three episodes of true patellar dislocations. The preoperative radiographic examination included AP and lateral views to assess patella alta and limb alignment. Magnetic resonance imaging was performed to evaluate trochlear dysplasia and tibial tubercle–trochlear groove (TT-TG) distance. The patients were questioned regarding complications and clinical outcomes using the VAS, Kujala, and Pedi-IKDC scores. The influence of gender on the postoperative outcomes was analyzed.

Results

The mean age at the time of operation was 13.04 years (9-16 years). The cohort was followed for a mean duration of 38.66 months (24-86 months). The mean time from injury to surgery was 50.45 days (16-80 days). No growth arrest, limb-length discrepancies, or angular deformities were observed postoperatively during the whole follow-up period. No patellar re-dislocations were recorded throughout the study period. The VAS score improved significantly from 5.67(4-8) to 1.88(0-4) (P<0.01). The Kujala score improved significantly from 64.67(44-81) preoperatively to 87.58(77-100) postoperatively (P<0.01). The Pedi-IKCD also increased significantly from 58.81(34.80-77.70) preoperatively to 90.64(70.70-100) post-operatively (P<0.01). Most patients (87.5%) returned to their pre-injury activity level. Boys scored better than girls in VAS, Pedi-IKCD, and Kujala score post-operatively but these differences were not statistically significant.

Conclusion

Physeal-sparing MPFL reconstruction in children and adolescents yields excellent midterm results and allows patients to return to sports without redislocation of the patella. Boys scored better than girls in VAS, Pedi-IKCD, and Kujala score post-operatively but these differences were not statistically significant.