Outcomes of medial patellofemoral ligament reconstruction and tibial tubercle osteotomy in syndromic adolescents with patellar dislocation

Ahmet Imerci; Tyler C McDonald; Kenneth J Rogers; Mihir M Thacker; Alfred Atanda Jr

doi:10.1016/j.jcot.2022.101770

Outcomes of medial patellofemoral ligament reconstruction and tibial tubercle osteotomy in syndromic adolescents with patellar dislocation

J Clin Orthop Trauma. 2022 Jan 14:25:101770. doi: 10.1016/j.jcot.2022.101770. eCollection 2022 Feb.

Authors

Ahmet Imerci¹, Tyler C McDonald², Kenneth J Rogers², Mihir M Thacker², Alfred Atanda Jr²

Affiliations

¹ Department of Orthopaedics and Traumatology, Faculty of Medicine, Mugla Sitki Kocman University, Kötekli Mahallesi, 48000, Menteşe, Mŭgla, Turkey.
² Department of Orthopaedic Surgery, Nemours/Alfred I. DuPont Hospital for Children, 1600 Rockland Rd., Wilmington, DE, 19803, USA.

Abstract

Background: Treatment of congenital and habitual dislocation of the patella in syndromic adolescents can be difficult due to accompanying soft-tissue and/or osseous abnormalities often present in the knee. The aim of this study was to report the results of surgical treatment of congenital and habitual patellar dislocation with medial patellofemoral ligament (MPFL) reconstruction and tibial tubercle osteotomy (TTO) in adolescents with an underlying syndrome.

Methods: Syndromic adolescent patients with congenital or habitual patellar dislocation treated with MPFL reconstruction and TTO between 2005 and 2019 with a minimum of one year of follow-up were identified. Demographic, clinical, radiographic, and surgical data were recorded, and any complications were noted. Kujala and Lysholm scores were used to quantitate knee function.

Results: Seventeen knees in 11 patients met the criteria for inclusion. The mean age at operation was 14.8 years (range, 13.3-18.3 years). Patients were identified as having Ehlers-Danlos (four), Down (two), trichorhinophalangeal (one), McCune-Albright (one), Klippel-Feil (one), and generalized joint hypermobility (two) syndromes. The mean follow-up was 2.2 years for each individual knee (range, 1-5.9 years). The mean Kujala score increased from 56 ± 10 preoperatively to 86 ± 6 at the most recent postoperative visit (p < 0.001). The mean Lysholm score increased from 53 ± 10 preoperatively to 85 ± 7 at the most recent postoperative visit (p < 0.001). Knee flexion increased significantly from 117° ± 15° preoperatively to 154° ± 13° postoperatively (p < 0.001). However, knee extension was no different pre- and postoperatively (4° ± 8° vs. 1° ± 4°, respectively, p = 0.2).

Conclusions: Congenital and habitual patellar dislocation in adolescent-aged patients with an underlying syndromic diagnosis can be successfully treated with MPFL reconstruction combined with TTO.

Keywords: Dislocation of the patella; MPFL; Medial patellofemoral ligament; Patellar dislocation; Reconstruction; Syndromic adolescent; Tibial tubercle osteotomy.