title: Acquired femoral flexion deformity due to physeal injury during medial patellofemoral ligament reconstruction.
abstract: BACKGROUND
  Reconstruction of the medial patellofemoral ligament (MPFL) is the most frequent surgical procedure performed in patients with patellar instability. Recently, concerns regarding physeal injury during femoral tunnel placement for anatomical MPFL reconstruction in children have been discussed.
  
  
  METHODS
  This is the first case to report partial posterior physeal growth arrest and subsequent flexion deformity of the distal femur after MPFL reconstruction in a skeletally immature patient. The cause and treatment are discussed.
  
  
  RESULTS
  Postoperative knee extension deficit and recurrent patellar instability were successfully treated with revision surgery including, distal femoral extension osteotomy, medialization of the tibial tuberosity, trochleoplasty and MPFL graft tensioning.
  
  
  CONCLUSIONS
  This case highlights that care should be taken during femoral tunnel placement for anatomic graft fixation to avoid physeal injuries in skeletally immature patients.
authors.affiliation: Department of Orthopedic Surgery Oberndorf, Academic Teaching Hospital of the Paracelsus Medical University, Paracelsusstrasse 37, 5110 Oberndorf, Austria. Electronic address: g.seitlinger@gmx.de.
authors.forename: Gerd
authors.initials: G
authors.lastname: Seitlinger
authors.affiliation: Center for Musculoskeletal Surgery, Campus Virchow, Charité -Universitaetsmedizin, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: philipp.moroder@charite.de.
authors.forename: Philipp
authors.initials: P
authors.lastname: Moroder
authors.affiliation: Gelenkpunkt - Center for Sports and Joint Surgery, Olympiastraße 39, 6020 Innsbruck, Austria; Research Unit of Orthopedic Sports Medicine and Injury Prevention, Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT, Eduard-Wallnöfer-Zentrum 1, 6060 Hall in Tirol, Austria. Electronic address: c.fink@gelenkpunkt.com.
authors.forename: Christian
authors.initials: C
authors.lastname: Fink
authors.affiliation: Department of Orthopaedics and Traumatology, Paracelsus Medical University Salzburg, Muellner Hauptstrasse 48, 5020 Salzburg, Austria. Electronic address: wierer@gmail.com.
authors.forename: Guido
authors.initials: G
authors.lastname: Wierer
mesh_terms: D000293:Adolescent; D004838:Epiphyses / Q000293:injuries*; D005260:Female; D005269:Femur / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery; D007719:Knee Joint / Q000503:physiopathology* / Q000601:surgery; D008023:Ligaments, Articular / Q000601:surgery*; D057071:Patellofemoral Joint / Q000503:physiopathology; D011183:Postoperative Complications; D016059:Range of Motion, Articular / Q000502:physiology*; D012086:Reoperation; D013710:Tendons / Q000637:transplantation
keywords: Complication; Extension deficit; Flexion deformity; MPFL; Medial patellofemoral ligament reconstruction; Revision