Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Würnschimmel, C.
Medial Patellofemoral Ligament Reconstruction for the Treatment of Patellofemoral Instability in Pediatric Patients
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2015. pp.
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Sperl Matthias
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- Abstract:
- ///Introduction and hypothesis/// Treatment of patellar instability in pediatric patients offers a challenging situation. Due to skeletal immaturity some of the therapies used for adult patients are not suitable for children. For this reason treatment of patellofemoral instability in children focuses on soft-tissue procedures. One option is the reconstruction of the medial patellofemoral ligament by using an autologous semitendinosus or gracilis tendon. This ligament plays a major role in the stabilization of the patella and its reconstruction has already showed encouraging results for the treatment of patellofemoral instability in adult patients. The hypothesis for this study was that medial patellofemoral ligament reconstruction is a suitable method for treating patellofemoral instability in skeletally immature patients and significantly improves their subjective and objective outcome. ///Patients and Methods/// By using subjective scores and performing a follow up examination, this study investigates the outcome of isolated reconstruction and reconstruction combined with tibial tuberosity transfer in 23 pediatric patients between the ages 14 and 18. Additionally, patella alta and trochlear dysplasia were assessed and eventual changes of patellar height after reconstruction were evaluated by comparing preoperative to postoperative radiographs, ///Results/// All patients had a trochlear dysplasia. Subjective scores increased significantly and general patient satisfaction in the long term follow up was satisfying. 87% of the patients would choose to re-perform this surgery if they had to decide anew. Two patients experienced recurrent subluxation and redislocation appeared in one patient. Patellar height did not decrease significantly after surgery. ///Conclusion/// Reconstruction of the MPFL and also combined treatment with tibial tubercle transfer in indicated knees is a valuable method for treating recurrent patellar instability effectively in adult patients as well as pediatric patients. The limiting factor is severe trochlea dysplasia which cannot be addressed with soft tissue technics.