Medial patellofemoral ligament (MPFL) reconstruction in combination with a modified grammont technique leads to favorable mid-term results in adolescents with recurrent patellofemoral dislocations

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2018-03, Vol.26 (3), p.705-709
• Main Authors: Wegmann, Helmut, Würnschimmel, Christoph, Kraus, Tanja, Singer, Georg, Eberl, Robert, Till, Holger, Sperl, Matthias
• Format: Article
• Language: English
• Subjects: Adolescents; Biocompatibility; Biomedical materials; Dislocation; Dislocations; Dysplasia; Knee; Magnetic resonance imaging; Medicine; Medicine & Public Health; Orthopedics; Patients; Stability; Teenagers
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-017-4425-x

Purpose The aim of the present study is to present the outcome of a cohort of adolescent patients with trochlear dysplasia and elevated tibial tuberosity trochlear groove (TTTG) distance suffering from recurrent patellar dislocation. Treatment consisted of medial patellofemoral ligament (MPFL) reconstruction and a modified Grammont procedure. Methods MRI examinations were obtained pre- and postoperatively. Trochlear dysplasia was classified according to Déjour, and TTTG was measured on MRI. The Tegner Activity Scale and the Kujala Knee Score were assessed preoperatively and at follow-up. The Kujala Knee score and the IKDC 2000 knee score were documented at follow-up (median 50, range 20–61 months; SD 16.6). Results Seven knees of six patients (median age 16.5 years, range 14–17 years) with trochlear dysplasia and elevated TTTG distance (median 17 mm, range 16.1–21.9 mm; SD 2.8) were treated. Trochlear dysplasia was classified as Déjour type A in 1, type B in 5, and type C in 1 knee. The Kujala Knee Score significantly increased from values of 55 (range 17–88; SD 25.9) to 94 (range 73–100; SD 9.1) at follow-up ( p  = 0.028). TAS improved from preoperative 2 (range 0–7; SD 2.5) to 5 (range 4–9; SD 1.8) at follow-up ( p  = 0.034). Median IKDC 2000 Knee Score at follow-up was 89 (range 61–100, SD 13.4). No re-dislocations were encountered. Conclusion In selected adolescents with recurrent patellofemoral instability, MPFL reconstruction in combination with a modified Grammont technique yields excellent functional outcome and could, therefore, help to avoid major procedures, such as osteotomies. Level of evidence Therapeutic, Level IV.