title: Medial patellofemoral ligament (MPFL) reconstruction in combination with a modified grammont technique leads to favorable mid-term results in adolescents with recurrent patellofemoral dislocations.
abstract: OBJECTIVE
  The aim of the present study is to present the outcome of a cohort of adolescent patients with trochlear dysplasia and elevated tibial tuberosity trochlear groove (TTTG) distance suffering from recurrent patellar dislocation. Treatment consisted of medial patellofemoral ligament (MPFL) reconstruction and a modified Grammont procedure.
  
  
  METHODS
  MRI examinations were obtained pre- and postoperatively. Trochlear dysplasia was classified according to Déjour, and TTTG was measured on MRI. The Tegner Activity Scale and the Kujala Knee Score were assessed preoperatively and at follow-up. The Kujala Knee score and the IKDC 2000 knee score were documented at follow-up (median 50, range 20-61 months; SD 16.6).
  
  
  RESULTS
  Seven knees of six patients (median age 16.5 years, range 14-17 years) with trochlear dysplasia and elevated TTTG distance (median 17 mm, range 16.1-21.9 mm; SD 2.8) were treated. Trochlear dysplasia was classified as Déjour type A in 1, type B in 5, and type C in 1 knee. The Kujala Knee Score significantly increased from values of 55 (range 17-88; SD 25.9) to 94 (range 73-100; SD 9.1) at follow-up (p = 0.028). TAS improved from preoperative 2 (range 0-7; SD 2.5) to 5 (range 4-9; SD 1.8) at follow-up (p = 0.034). Median IKDC 2000 Knee Score at follow-up was 89 (range 61-100, SD 13.4). No re-dislocations were encountered.
  
  
  CONCLUSIONS
  In selected adolescents with recurrent patellofemoral instability, MPFL reconstruction in combination with a modified Grammont technique yields excellent functional outcome and could, therefore, help to avoid major procedures, such as osteotomies.
  
  
  METHODS
  Therapeutic, Level IV.
authors.affiliation: Department of Paediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria. helmut.wegmann@medunigraz.at.
authors.forename: Helmut
authors.initials: H
authors.lastname: Wegmann
authors.affiliation: Department of Paediatric Orthopedics, Medical University of Graz, Graz, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Würnschimmel
authors.affiliation: Department of Paediatric Orthopedics, Medical University of Graz, Graz, Austria.
authors.forename: Tanja
authors.initials: T
authors.lastname: Kraus
authors.affiliation: Department of Paediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Singer
authors.affiliation: Department of Paediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria.
authors.forename: Robert
authors.initials: R
authors.lastname: Eberl
authors.affiliation: Department of Paediatric and Adolescent Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036, Graz, Austria.
authors.forename: Holger
authors.initials: H
authors.lastname: Till
authors.affiliation: Department of Paediatric Orthopedics, Medical University of Graz, Graz, Austria.
authors.forename: Matthias
authors.initials: M
authors.lastname: Sperl
mesh_terms: D000293:Adolescent; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008023:Ligaments, Articular / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D031222:Patellar Dislocation / Q000175:diagnosis / Q000601:surgery*; D057071:Patellofemoral Joint / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*
keywords: Grammont technique; Medial patellofemoral ligament; Patellofemoral instability; Tibial tuberosity trochlear groove; Trochlear dysplasia