Technique for Implant-Free Medial Patello-femoral Ligament Reconstruction Using Tensor Fascia Lata Graft in Pediatric Patellar Instability.

Abstract

Patellar dislocation in children and adolescents, particularly habitual and congenital types, is a challenging condition that can cause significant functional impairment and long-term morbidity if untreated. Medial patellofemoral ligament (MPFL) is a critical structure in stabilizing the patella, and its reconstruction has been widely attempted in clinical practice using various tissue autografts. The same has been extensively published for adults; however, not many studies have been published in pediatric patients with habitual patellofemoral instability using the iliotibial band as a graft without implants. This study proposes a novel technique for MPFL reconstruction using a TFL graft without implants, coupled with modified vastus medialis oblique (VMO) advancement, aimed at restoring normal knee function and preventing habitual patellar dislocation in children. This study included pediatric patients aged 6-16 years with habitual or congenital patellar dislocation. Clinical diagnoses were based on history, physical examination, and imaging studies. Exclusion criteria involved patients with neurovascular conditions, severe skeletal deformities, traumatic dislocations, or prior knee surgeries. The surgical procedure comprised four key interventions: lateral release, fractional lengthening of the TFL, MPFL reconstruction using the TFL graft without implants, and modified VMO advancement. The outcomes were measured using the Kujala Patello-femoral Score, assessing pain, knee stability, and return to function, with follow-up assessments ranging from 3 months to 2 years. Seventeen patients (20 knees) were included in the study, with an average age of 8.75 years. The mean post-operative Kujala score was 93.25, indicating significant improvement in knee function. Postoperative pain was minimal (mean score 9), normal patellar tracking, and patients showed excellent recovery in dynamic movements, such as running and jumping. A complication of wound dehiscence with knee flexion contracture occurred in one patient, which was treated with wound debridement and secondary suturing. Importantly, there were no instances of recurrence of patellar dislocation. The modified MPFL reconstruction technique using a TFL graft without implants, combined with modified VMO advancement, proved to be an effective surgical solution for treating habitual and congenital patellar dislocation in pediatric patients. This technique offers excellent functional outcomes, with minimal complications and no recurrence of dislocation, while avoiding the need for implants, thus reducing the potential growth disturbances and associated morbidity.