title: Clinical outcome after reconstruction of the medial patellofemoral ligament in paediatric patients with recurrent patella instability.
abstract: OBJECTIVE
  Medial patellofemoral ligament (MPFL) reconstruction has recently been broadly accepted as primary surgical treatment in adults. Reconstruction techniques with osseous fixation in femur cannot be used for patients with open growth plates. Operative treatment of patella instability in children therefore is a challenge and requires alternative MPFL reconstruction techniques. Limited knowledge exists concerning outcome after MPFL reconstruction in children and adolescents. This study present clinical outcome in a consecutive single clinic series of children treated with paediatric MPFL reconstruction using a soft tissue femoral fixation technique.
  
  
  METHODS
  Twenty-four MPFL reconstructions in 20 operated children aged 8-16 were included in the study. Indication for surgery was two or more patella dislocations. MPFL reconstruction was performed by looping the released gracilis tendon around the adductor magnus tendon insertion and through drill holes in the proximal medial patella edge. Clinical outcome was evaluated by Kujala score and NRS pain score preoperatively, at 1-year follow-up and final follow-up at 39 months. Outcome was compared with a cohort of 179 adult patients with recurrent patella instability operated with an adult MPFL reconstruction technique.
  
  
  RESULTS
  Kujala score improved from 61 (13) to 81 (16). NRS pain score improved from 3.0 (3.1) to 1.5 (1.3) in activity. Four patients (20%) experienced redislocation within the first postoperative year compared with 5% in an adult patient population. Five patients (25%) experienced subluxations. One patient with a redislocation was re-operated with adult MPFL reconstruction technique. Cartilage injury was seen in six patients.
  
  
  CONCLUSIONS
  There are clinical relevant improvements in knee function and pain after MPFL reconstruction in paediatric patients. Patella stability after MPFL reconstruction using femoral soft tissue graft fixation in paediatric patients was inferior to MPFL reconstruction using bony femoral fixation in adult patients.
  
  
  METHODS
  Case-Control study, Level III.
authors.affiliation: Division of Sports Trauma, Orthopaedic Department, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Århus C, Denmark. martinlind@dadlnet.dk.
authors.forename: Martin
authors.initials: M
authors.lastname: Lind
authors.affiliation: Division of Sports Trauma, Orthopaedic Department, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Århus C, Denmark.
authors.forename: Ditte
authors.initials: D
authors.lastname: Enderlein
authors.affiliation: Division of Sports Trauma, Orthopaedic Department, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Århus C, Denmark.
authors.forename: Torsten
authors.initials: T
authors.lastname: Nielsen
authors.affiliation: Division of Sports Trauma, Orthopaedic Department, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Århus C, Denmark.
authors.forename: Svend Erik
authors.initials: SE
authors.lastname: Christiansen
authors.affiliation: Division of Sports Trauma, Orthopaedic Department, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Århus C, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Faunø
mesh_terms: D000293:Adolescent; D000328:Adult; D064592:Autografts; D016022:Case-Control Studies; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008023:Ligaments, Articular / Q000293:injuries / Q000601:surgery*; D008297:Male; D010329:Patella / Q000601:surgery; D031222:Patellar Dislocation / Q000209:etiology / Q000601:surgery*; D057071:Patellofemoral Joint / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D013710:Tendons / Q000637:transplantation*; D055815:Young Adult
keywords: Ligament reconstruction; MPFL; Medial patellofemoral ligament; Patella instability