Current Practices in Medial Patellofemoral Ligament Reconstruction (MPFL-R) for Pediatric and Adolescent Patients: Insights From South America.

Abstract

This study aimed to evaluate the current trends and practices in medial patellofemoral ligament reconstruction (MPFL-R) among pediatric and adolescent patients in South America. A cross-sectional web-based survey consisting of 21 questions, Supplemental Digital Content 1, http://links.lww.com/BPO/A960 was distributed to members affiliated with 4 pediatric orthopaedic societies from Argentina, Brazil, Chile, and Colombia. The survey collected data on demographics, patient selection criteria, surgical preferences, graft choice, fixation methods, and use of adjunctive procedures. Descriptive statistics (mean and SD) were calculated for continuous variables and frequencies. Percentages were calculated to summarize qualitative data. A total of 132 completed surveys were collected, with the following distribution: Argentina (11.4%), Brazil (61.4%), Colombia (10.6%), and Chile (16.7%). Sixty percent of the participants had been in practice for more than 10 years. Most surgeons (84.8%) favored autografts, with semitendinous (54.5%) and quadriceps tendons (41.7%) being the most common choices. Preferences for femoral fixation included suture anchors (41.7%) and interference screws (37.9%), whereas patellar fixation preferences included suture anchors (48.5%), periosteum-based (36.4%), and patellar tunnels, (15.2%). There were diverse practices in distal realignment techniques and variable indications and approaches for derotation osteotomy in patients with femoral anteversion across the surveyed countries. Most surgeons (55.3%) preferred staging-guided growth and MPFL-R for skeletally immature patients with significant genu valgum. A common trend identified was the limited experience with trochleoplasty techniques. This survey revealed substantial variability in MPFL-R practices among pediatric orthopaedic surgeons in South America. These findings underscore the need for standardized guidelines and further research to optimize surgical outcomes in pediatric and adolescent patients. Understanding regional differences can inform future collaborative efforts to develop best practices and improve patient care in this population. Level V.