Reconstruction of the Medial Patellofemoral Ligament with Adductor Magnus Tendon in Pediatric Patients with Patella Instability

Abstract

Introduction: The medial patellofemoral ligament is considered the main medial stabilizer of the patella. Reconstruction is indicated in patients with recurrent dislocation, when conservative treatment has failed.

Objective: To describe and evaluate a reconstruction technique of the medial patellofemoral ligament with the adductor magnus tendon in patients with an immature skeleton.

Methods: Anatomical and descriptive study of patients in which the adductor magnus tendon was used to reconstruct the medial patellofemoral ligament. After surgery, reluxation, instability and satisfaction were evaluated with Kujala scale. Results: Five pieces of fresh corpses were dissected. The adductor magnus tendon was 8 to 9 cm long. Eight surgeries were performed in seven patients between 817 years old, one of them with Down syndrome. The minimum followup period was 12 months. There was no relaxation. The patient with Down syndrome had patellar subluxation. The flexion and extension of the knees was complete.

Conclusions: The reconstruction of the medial patellofemoral ligament causes difficulties in patients with immature skeleton, plate growth of the distal femur close to the isometric point of the ligament. The technique described by Avikainen allows non-anatomical reconstruction of the ligament without performing femoral tunnels that put the physis at risk. This paper describes the adductor magnus technique. Only one knee, out of the eight operated, had subluxation.  The rest had good result, with no dislocation, and the patients were satisfied with the result.