MPFL Reconstruction with Soft Tissue Femoral Fixation Technique in a Case of Congenital Patellar Dislocation with Long-term Follow-up: a Case Report

Abstract

Background

Congenital patellar dislocation (CPD) is a rare condition in which the patella is laterally dislocated at birth. Surgical intervention is typically required due to abnormal knee development.

Methods

This case report details a successful application of medial patellofemoral ligament reconstruction using a femoral soft-tissue fixation technique (ST-MPFL-R), combined with lateral release and vastus medialis advancement in a 7-year-old boy with CPD.

Results

ST-MPFL-R combined with lateral release and vastus medialis led to satisfactory results.

Conclusion

This approach avoided damaging growth plates and achieved patellar stability at six-year follow-up. While the application of ST-MPFL-R for CPD was reported for the first time, further research with larger patient groups is needed to definitively compare it to traditional methods.

Zusammenfassung

Hintergrund

Die angeborene Patellaluxation (CPD) ist eine seltene Erkrankung, bei der sich die Patella bei der Geburt seitlich verlagert. Aufgrund einer abnormalen Knieentwicklung ist i. d. R. ein chirurgischer Eingriff erforderlich.

Methoden

Dieser Fallbericht beschreibt eine erfolgreiche Anwendung der Rekonstruktion des medialen patellofemoralen Ligaments mit Weichgewebe-Femur-Fixierungstechnik (ST-MPFL-R) in Kombination mit lateraler Freisetzung und Vorwärtsbewegung des Vastus medialis bei einem 7-jährigen Jungen mit CPD.

Ergebnisse

Die ST-MPFL-R kombiniert mit lateraler Freisetzung und Vastus medialis führten zu zufriedenstellenden Ergebnissen.

Schlussfolgerung

Dieser Ansatz vermied eine Schädigung der Wachstumsfugen und erreichte nach 6 Jahren eine Patellastabilität. Während zunächst über die Anwendung von ST-MPFL-R bei CPD berichtet wurde, sind weitere Untersuchungen mit größeren Patientengruppen erforderlich, um es definitiv mit herkömmlichen Methoden vergleichen zu können.

Keywords

congenital patellar dislocation - medial patellofemoral ligament reconstruction - pediatric orthopedics - long-term follow-up

Schlüsselwörter

angeborene Patellaluxation - mediale patellofemorale Ligament-Rekonstruktion - Kinderorthopädie - Langzeitnachsorge

Publication History

Received: 25 May 2024

Accepted after revision: 06 May 2025

Article published online:
28 May 2025

• References

• 1 Stanisavljevic S, Zemenick G, Miller D. Congenital, irreducible, permanent lateral dislocation of the patella. Clin Orthop Relat Res 1976; (116) 190-199
• 2 Pedrotti L, Bertani B, De Rosa F. et al. Congenital Dislocation of the Patella – Surgical Treatment Rationale and Literature Review. J Orthop Case Rep 2021; 11: 59-64
• 3 Wada A, Fujii T, Takamura K. et al. Congenital dislocation of the patella. J Child Orthop 2008; 2: 119-123
• 4 Yan Z, Yao Y, Yang Q. et al. Application of ultrasound in the early diagnosis of congenital patellar dislocation: a case description. Quant Imaging Med Surg 2023; 13: 7362-7366
• 5 Bremond N, Prima R, Rabattu P. et al. Isolated MPFL reconstruction with soft tissue femoral fixation technique in 54 skeletally immature patients: Clinical outcomes at 2 years follow-up. A French multicenter retrospective study. Orthop Traumatol Surg Res 2023; 109: 103530
• 6 Carrillon Y, Abidi H, Dejour D. et al. Patellar instability: assessment on MR images by measuring the lateral trochlear inclination-initial experience. Radiology 2000; 216: 582-585
• 7 Grisdela P, Paschos N, Tanaka M. Fixed (Congenital) Patellar Dislocation. Clin Sports Med 2022; 41: 123-136
• 8 Parikh S, Veerkamp M, Redler L. et al. Patellar Instability in Young Athletes. Clin Sports Med 2022; 41: 627-651
• 9 Grisdela P, Paschos N, Tanaka M. Fixed (Congenital) Patellar Dislocation. Clin Sports Med 2022; 41: 123-136
• 10 Langenskiöld A, Ritsilä V. Congenital dislocation of the patella and its operative treatment. J Pediatr Orthop 1992; 12: 315-323
• 11 Miguel Sá P, Raposo F, Santos Carvalho M. et al. Congenital dislocation of the patella – clinical case. Rev Bras Ortop 2016; 51: 109-112
• 12 Imerci A, McDonald TC, Rogers KJ. et al. Outcomes of medial patellofemoral ligament reconstruction and tibial tubercle osteotomy in syndromic adolescents with patellar dislocation. J Clin Orthop Trauma 2022; 25: 101770
• 13 Mo Y, Jing Y, Wang D. et al. Modified Langenskiöld procedure for congenital patella dislocations in pediatric patients. BMC Musculoskelet Disord 2022; 23: 241
• 14 Ramos O, Burke C, Lewis M. et al. Modified Langenskiöld procedure for chronic, recurrent, and congenital patellar dislocation. J Child Orthop 2020; 14: 318-329
• 15 Roger J, Viste A, Cievet-Bonfils M. et al. Axial patellar engagement index and patellar tilt after medial patello-femoral ligament reconstruction in children and adolescents. Orthop Traumatol Surg Res 2019; 105: 133-138
• 16 Nomura E, Horiuchi Y, Kihara M. Medial patellofemoral ligament restraint in lateral patellar translation and reconstruction. Knee 2000; 7: 121-127
• 17 Nelitz M, Dreyhaupt J, Williams S. Anatomic reconstruction of the medial patellofemoral ligament in children and adolescents using a pedicled quadriceps tendon graft shows favourable results at a minimum of 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 2018; 26: 1210-1215
• 18 Chassaing V, Trémoulet J. Plastie du ligament fémoro-patellaire médial avec le tendon du gracile pour stabilisation de la patella [Medial patellofemoral ligament reconstruction with gracilis autograft for patellar instability]. Rev Chir Orthop Reparatrice Appar Mot 2005; 91: 335-340