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Anatomic reconstruction of the medial patellofemoral ligament in children and adolescents with open growth plates: surgical technique and clinical outcome.
[trochlear dysplasia]
Recurrent
lateral
patellar
dislocation
is
a
common
knee
injury
in
the
skeletally
immature
adolescent
.
Because
of
the
open
physis
,
operative
therapy
in
children
is
challenging
.
This
study
presents
the
outcomes
of
a
minimally
invasive
technique
for
anatomic
reconstruction
of
the
medial
patellofemoral
ligament
(
MPFL
)
in
children
that
respects
the
distal
femoral
physis
.
Anatomic
reconstruction
of
the
MPFL
in
children
that
maintains
the
distal
femoral
physis
will
prevent
redislocation
,
preserve
the
distal
femoral
physis
,
and
improve
knee
function
.
Case
series
;
Level
of
evidence
,
4
.
Twenty
-
one
consecutive
patients
with
patellofemoral
instability
and
open
growth
plates
underwent
anatomic
reconstruction
of
the
MPFL
that
maintained
the
distal
femoral
growth
plate
.
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
.
Evaluation
included
preoperative
and
postoperative
physical
examination
,
Kujala
score
,
and
Tegner
activity
score
.
The
average
age
at
the
time
of
operation
was
12
.
2
years
(
range
,
10
.
3
-
13
.
9
)
.
The
average
follow-up
after
operation
was
2
.
8
years
after
surgery
(
range
,
2
.
0
-
3
.
6
)
.
No
recurrent
dislocation
occurred
,
but
2
patients
with
high
-grade
trochlear
dysplasia
still
had
a
positive
apprehension
sign
.
The
Kujala
score
significantly
improved
from
72
.
9
(
range
,
37
-
87
)
preoperatively
to
92
.
8
(
range
,
74
-
100
)
postoperatively
(
P
<
.
01
)
.
The
Tegner
activity
score
decreased
,
but
not
significantly
,
from
6
.
0
(
range
,
3
-
9
)
preoperatively
to
5
.
8
(
range
,
3
-
9
)
postoperatively
(
P
=
.
48
)
.
Anatomic
reconstruction
of
the
MPFL
that
respects
the
distal
femoral
physis
in
skeletally
immature
patients
is
a
safe
and
effective
technique
for
the
treatment
of
patellofemoral
instability
and
allows
patients
to
return
to
sports
without
redislocation
of
the
patella
.
Diseases
Validation
Diseases presenting
"skeletally immature"
symptom
trochlear dysplasia
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