Outcomes of Allograft Medial Patellofemoral Ligament Reconstruction in Children and Adolescents with Hypermobility

Gautam Reddy; Prabhnoor Singh Hayer; Saif UlIslam; Nisarg J Mehta; Hafiz Javaid Iqbal; Gareth Stables; Nicholas G Barton-Hanson

doi:10.4103/ijabmr.ijabmr_25_22

Outcomes of Allograft Medial Patellofemoral Ligament Reconstruction in Children and Adolescents with Hypermobility

Int J Appl Basic Med Res. 2022 Jul-Sep;12(3):161-166. doi: 10.4103/ijabmr.ijabmr_25_22. Epub 2022 Jul 26.

Authors

Gautam Reddy¹, Prabhnoor Singh Hayer², Saif UlIslam¹, Nisarg J Mehta¹, Hafiz Javaid Iqbal³, Gareth Stables², Nicholas G Barton-Hanson⁴

Affiliations

¹ Liverpool University Hospitals, Warrington, England.
² Warrington and Halton Teaching Hospitals, Warrington, England.
³ Countess of Chester Hospital, Chester, England.
⁴ Alder Hey Children's Hospital, Liverpool, England.

Abstract

Introduction: Medial patellofemoral ligament (MPFL) reconstruction is used to treat patellofemoral instability either in isolation or in combination with other procedures. Use of allograft can preserve native tissue in children and can be advantageous in patients with connective tissue disorders, including ligamentous laxity. There is limited evidence regarding functional outcomes of allograft MPFL reconstruction in children and adolescents. This study aimed to assess the short to mid-term results of allograft MPFL reconstruction in children with hypermobility at a tertiary pediatric orthopedic center.

Materials and methods: We retrospectively reviewed all children and adolescents who had undergone allograft MPFL reconstruction over 4 years. The primary outcome measure was the validated Kujala score for patellofemoral disorders. The secondary outcome measures included complications such as redislocation of the patella needing revision surgery. Patients with hypermobility were quantified using Beighton criteria. Statistical analysis was performed using Graph Pad Prism (V6).

Results: Between 2012 and 2016, the senior author performed 76 allograft MPFL reconstructions in 57 patients. Nineteen patients had bilateral surgery. The mean age was 14 (7-16) years with a female: male ratio of 3:1. The mean Beighton score was 7. Hypermobility was part of a syndrome in ten patients. The mean follow-up was 3 (1-4) years. Nine patients had trochleoplasty and six patients had tibial tubercle osteotomy, in addition to allograft MPFL reconstruction. These fifteen patients, who had additional procedures, were excluded during the analysis of the outcome measures. The mean Kujala score was 89 (80-100). The overall complication rate was 11% (9/76). These included two patella fractures and seven (9%) patients with recurrent instability needing revision surgery. There was no significant difference in complication rates between syndromic and nonsyndromic patients (P = 0.9).

Conclusion: Our study shows excellent short to mid-term functional outcomes of allograft MPFL reconstruction in children and adolescents with hypermobility.

Keywords: Allograft; children and adolescents; hypermobility; medial patellofemoral ligament reconstruction; patella dislocation.