Tayne Samantha, Kim Billy I, Lau Brian C
Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.
Duke University School of Medicine, Durham, North Carolina, USA.
Video J Sports Med. 2022 Nov 8;2(6):26350254221115202. doi: 10.1177/26350254221115202. eCollection 2022 Nov-Dec.
Patellar instability is a common problem in the active pediatric population. Physeal sparing medial patellofemoral ligament (MPFL) reconstruction using a soft suture anchor for femoral graft fixation has the proposed advantages of diminishing volumetric bony removal from the epiphysis, increasing the margin of safety with respect to notch, trochlear, and/or physeal damage, as well as reducing the risk of thermal damage to the physis during socket reaming.
MPFL reconstruction is indicated in patients with recurrent patellar instability with MPFL tear or attenuation on magnetic resonance imaging or failure of conservative treatment. Physeal sparing techniques are necessary in the pediatric population to prevent growth disturbance and deformities that can lead to significant long-term disability.
The patient was placed in supine position. Following examination under anesthesia, diagnostic arthroscopy was performed to assess for patellofemoral chondral defects. The surgical technique required 6 steps: (1) medial patellar dissection, (2) patellar anchor placement with 1.8-mm suture anchors, (3) medial femoral dissection over Schottle's point, (4) femoral anchor placement using 2.8-mm double loaded anchor, (5) allograft femoral fixation, and (6) allograft patellar fixation. After skin closure, examination under anesthesia was repeated.
The patient was weight-bearing as tolerated immediately after surgery, using a brace for the first 6 weeks. Rehabilitation progressed from regaining range of motion, strengthening of the operative extremity, and returning to sport activities. In the senior author's experience using this technique, there have been no recurrent patellar dislocations and no evidence of growth disturbance or angulation. One patient did find that the graft was prominent over the femoral epicondyle and returned to the operating room for debulking at 9 months postoperatively.
DISCUSSION/CONCLUSION: In conclusion, we propose that physeal sparing MPFL reconstruction using soft anchors for patellar and femoral fixation offers a simple and safe technique with reproducible anatomic graft placement and favorable clinical outcomes. This technique is technically simple and can be easily learned by surgeons familiar with adult MPFL reconstruction techniques.The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
髌骨不稳定是活跃的儿科人群中的常见问题。使用软缝合锚钉进行骺板保留的内侧髌股韧带（MPFL）重建术，用于股骨移植物固定，具有减少骨骺体积性骨切除、增加相对于切迹、滑车和/或骺板损伤的安全 margin、以及降低扩孔时对骺板热损伤风险等优势。
MPFL重建适用于磁共振成像显示MPFL撕裂或衰减的复发性髌骨不稳定患者，或保守治疗失败的患者。在儿科人群中，骺板保留技术对于预防可导致严重长期残疾的生长紊乱和畸形是必要的。
患者取仰卧位。麻醉下检查后，进行诊断性关节镜检查以评估髌股软骨缺损。手术技术需要6个步骤：（1）髌骨内侧解剖，（2）用1.8毫米缝合锚钉放置髌骨锚，（3）在肖特尔点上方进行股骨内侧解剖，（4）使用2.8毫米双负载锚钉放置股骨锚，（5）同种异体移植物股骨固定，（6）同种异体移植物髌骨固定。皮肤缝合后，再次进行麻醉下检查。
患者术后立即根据耐受情况负重，最初6周使用支具。康复过程包括恢复活动范围、加强手术肢体力量以及恢复体育活动。根据资深作者使用该技术的经验，没有复发性髌骨脱位，也没有生长紊乱或成角的证据。一名患者发现移植物在股骨髁上突出，术后9个月返回手术室进行减容。
讨论/结论：总之，我们认为使用软锚钉进行骺板保留的MPFL重建术，用于髌骨和股骨固定，提供了一种简单安全的技术，具有可重复的解剖移植物放置和良好的临床结果。该技术在技术上简单，熟悉成人MPFL重建技术的外科医生可以轻松学会。作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本提交出版物附上患者的豁免声明或其他书面批准形式。
