MPFL Reconstruction Also Successful in Pediatric Patients

Researchers from Hospital for Special Surgery (HSS) recently documented their success with using the epiphyseal femoral socket for pediatric patients undergoing medial patellofemoral ligament (MPFL) reconstruction.

Their study, “Medial patellofemoral ligament (MPFL) reconstruction technique using an epiphyseal femoral socket with fluoroscopic guidance helps avoid physeal injury in skeletally immature patients,” was published in the November 2019 issue of Knee Surgery, Sports Traumatology, Arthroscopy.

Daniel W. Green, M.D., MS, FACS, senior author of the study, director of Pediatric Orthopedic Surgery Fellowship and associate director of the orthopedic surgery residency program at HSS in New York assessed, along with his colleagues, the physeal safety in 54 knees in 49 pediatric patients who underwent physeal-sparing MPFL reconstruction.

All MPFL reconstructions were performed by one surgeon between 2007 and 2016. Each patient post-operatively had a MRI of the operative knee or standing hip-to-ankle radiographs.

According to the data collected, five patients had recurrent patellar instability and three needed to have subsequent tibial tubercle osteotomy or revision MPFL reconstruction. The researchers found no evidence of physeal arrest and the median distance from the physis to the socket at the aperture and distal end of the femoral socket were 5.9 mm (range, 1.9-12) and 7.1 mm (1.3-12.4), respectively.

They wrote, “These results demonstrate that with fluoroscopic guidance, placing the femoral socket distal to the distal femoral physis is an effective method for avoiding physeal injury and subsequent growth disturbances in children with patellar instability.”

Green told OTW, “The results in the paper demonstrate that patella stabilization surgery with MPFL reconstruction can be performed safely and effectively in young patients with open growth plates.”

“The success rate of surgery for patients with recurrent patella dislocation has improved dramatically once surgeons began performing a medial patella ligament reconstruction. Patella stability success rate jumped from 50% to over 90%.”

He added, “We are proud at Hospital for Special Surgery to be one of the FIRST hospitals in the country to perform MPFL surgery in children and adolescents who suffer from patella dislocations. The results in the paper demonstrate that the surgery can be performed safely and effectively in patients who are growing.”