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

Abstract

In adults, reconstruction of the medial patellofemoral ligament (MPFL) has shown good results. Treatment for recurrent patellar instability in children and adolescents with open growth plates, however, requires alternative MPFL reconstruction techniques. This study presents the outcomes of a minimally invasive technique for anatomic reconstruction of the MPFL in children using a pedicled superficial quadriceps tendon graft, hardware-free patellar graft attachment, and anatomic femoral fixation that spares the distal femoral physis. Twenty-five consecutive patients with patellofemoral instability and open growth plates underwent anatomic reconstruction of the MPFL using a pedicled superficial quadriceps tendon graft. 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 distance. Evaluation included pre- and post-operative physical examination, Kujala score, visual analog scale (VAS), and Tegner activity score. The average age at the time of operation was 12.8years (9.5-14.7). The average follow-up after operation was 2.6years (2.0-3.4). No recurrent dislocation occurred. Twenty patients were very satisfied (80%), four patients were satisfied (16%), and one patient was partially satisfied with the surgical procedure (4%). No patient was dissatisfied. The median Kujala score significantly improved from 63 (44-81) preoperatively to 89 (77-100) post-operatively (P<0.01), and the median VAS score improved significantly from 4 (1-7) to 1 (0-4) (P<0.01). The Tegner activity score increased, but not significantly, from 4 (3-8) preoperatively to 5 (3-8) post-operatively (non-significant). The described technique for MPFL reconstruction with a pedicled quadriceps tendon is a safe and effective technique with good clinical results and allows patients to return to sports without redislocation of the patella. It might therefore be a valuable alternative to more extensive procedures in paediatric and adolescent patients. Prospective study, Level III.