Axial patellar engagement index and patellar tilt after medial patello-femoral ligament reconstruction in children and adolescents

Autor: F. Chotel, Maxime Cievet-Bonfils, Julien Roger, J. P. Pracros, Sébastien Raux, Anthony Viste
Přispěvatelé: Department of paediatric orthopaedic surgery, Hôpital Femme Mère Enfant [CHU - HCL] (HFME), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Laboratoire de Biomécanique et Mécanique des Chocs (LBMC UMR T9406), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux (IFSTTAR), Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Department of radiology
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Male
Muscle Relaxation
Quadriceps Muscle
Tendons
Patellofemoral Joint
[SPI]Engineering Sciences [physics]
0302 clinical medicine
Orthopedic Procedures
Orthopedics and Sports Medicine
PATELLAR TILT
Prospective Studies
Child
Prospective cohort study
030222 orthopedics
Medial collateral ligament
Lateral retinaculum
medicine.diagnostic_test
Soft tissue
[SPI.MECA.BIOM]Engineering Sciences [physics]/Mechanics [physics.med-ph]/Biomechanics [physics.med-ph]
Patella
musculoskeletal system
Magnetic Resonance Imaging
PEDIATRIC PATIENT
medicine.anatomical_structure
Ligaments
Articular
Ligament
Female
Muscle Contraction
Joint Instability
musculoskeletal diseases
medicine.medical_specialty
Adolescent
Physical examination
03 medical and health sciences
BIOMECANIQUE
medicine
Humans
Subluxation
business.industry
Magnetic resonance imaging
030229 sport sciences
Plastic Surgery Procedures
medicine.disease
PATELLAR INSTABILITY
LATERAL PATELLAR TRANSLATION
Surgery
MEDIAL PATELLO-FEMORAL LIGAMENT
Tomography
X-Ray Computed
Nuclear medicine
business
Follow-Up Studies
Zdroj: Orthopaedics and Traumatology-Surgery and Research
Orthopaedics and Traumatology-Surgery and Research, Elsevier, 2019, 105 (1), pp. 133-138. ⟨10.1016/j.otsr.2018.10.002⟩
ISSN: 1877-0568
DOI: 10.1016/j.otsr.2018.10.002⟩
Popis: Background The medial patello-femoral ligament (MPFL) is a major patellar stabiliser whose reconstruction in adults involves graft fixation within a femoral tunnel. In skeletally immature patients, in contrast, the graft is fixed to the soft tissues to allow normal growth. The primary objective of this prospective study was to perform computed tomography (CT) and magnetic resonance imaging (MRI) assessments of medium-term correction of patellar tilt and of the axial patellar engagement index (AEI) after a paediatric variant of MPFL reconstruction in skeletally immature patients. Hypothesis MPFL reconstruction, performed alone or combined with other procedures in skeletally immature patients, decreases patellar tilt and improves the AEI. Material and methods Eighteen children and adolescents with a median age of 14.6 years (range, 8–17 years) who underwent MPFL reconstruction on 20 knees were included in this prospective observational study. A double-strand gracilis tendon graft passed through the medial collateral ligament was used. MPFL reconstruction was performed alone in 13 knees and was combined with lateral retinaculum release, tibial tuberosity translation, and/or trochleoplasty in 7 knees. Patellar tilt and AEI values determined on preoperative and post-operative imaging studies with the quadriceps relaxed and contracted were compared. A physical examination was also performed. Results From baseline to last follow-up after a mean of 43 months (range, 24–63 months), patellar tilt decreased from 20° preoperatively to 9° with the quadriceps relaxed and from 33° to 15.4° with the quadriceps contracted. The AEI increased from 0.78 at baseline to 0.93 at last follow-up. No dislocation or subluxation recurrences were recorded during follow-up. Discussion The patellar tilt and AEI improvements seen after paediatric MPFL reconstruction confirm the study hypothesis. This is the first prospective study of patellar position in the axial plane as assessed by CT and MRI after paediatric MPFL reconstruction. In everyday clinical practice, 3D assessments of patellar tilt and the AEI should be performed to evaluate correction of the abnormalities. Level of evidence II, non-randomised prospective observational study.
Databáze: OpenAIRE
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