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A Magnetic Resonance Imaging Study of the Significance of the Distal Femoral Physis During Medial Patellofemoral Ligament Reconstruction.

Greenrod W, Cox J, Astori I, Baulch J, Williams J - Orthop J Sports Med (2013)

Bottom Line: Results are plotted against age and compared as quartile ranges.The femoral insertion of the MPFL was found to be distal to the distal femoral physis in all patients by an average of 10 mm (range, 2-16 mm).However, in children older than 10 years, a 20-mm screw, from the anatomic MPFL insertion and directed 45° distally oblique, should be safe in 98% of patients.

View Article: PubMed Central - PubMed

Affiliation: Mater Children's Hospital, Brisbane, Queensland, Australia. ; School of Medicine, University of Queensland, Brisbane, Queensland, Australia.

ABSTRACT

Background: Medial patellofemoral ligament (MPFL) reconstruction in adults often utilizes screw fixation in the distal femur. The aim was to define the safety of similar fixation in young patients, with respect to their open physis.

Purpose: To define the age-related relationship between the femoral insertion of the MPFL and the medial aspect of the distal femoral physis on magnetic resonance imaging (MRI) scans. The study investigates whether screw fixation at this point is safe with respect to patient age and screw inclination.

Study design: Cross-sectional study.

Methods: Retrospective review of the MRI scans of 159 skeletally immature patients. The femoral insertion of the MPFL was defined with respect to the distal femoral physis. The predicted paths of 2-cm screw fixation were simulated both parallel to the joint line and 45° distally oblique; physeal and joint penetration were noted when present. Results are plotted against age and compared as quartile ranges.

Results: The femoral insertion of the MPFL was found to be distal to the distal femoral physis in all patients by an average of 10 mm (range, 2-16 mm). The mean distance increases slightly with age in a nonlinear relationship (r = 0.51, P < .001) from 9 mm at age 10 years to 12 mm by age 16 years. For the classic, parallel screw, the risk of physeal breach is high for all age groups (mean, 64%). For the novel, oblique screw, joint penetration and physeal breach were less prevalent (mean, 13%), and importantly, the vast majority of these breaches were in younger children (age <9 years 9 months). With oblique screws, older children were at significantly lower risk than younger children (<3% vs 48%; P < .001).

Conclusion: This study accurately defines the relationship between the femoral insertion of the MPFL and the distal femoral physis in children and adolescents. A high risk of potentially poor outcomes was found during anatomic reconstruction of the MPFL in children utilizing classic (parallel) screw fixation, irrespective of age. However, in children older than 10 years, a 20-mm screw, from the anatomic MPFL insertion and directed 45° distally oblique, should be safe in 98% of patients.

No MeSH data available.


Risk of physeal breach or joint penetration by age quartiles and screw direction. Note that parallel screws pose significant risk at all ages, while oblique screws appear significantly safer in all but the youngest children.
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fig4-2325967113502638: Risk of physeal breach or joint penetration by age quartiles and screw direction. Note that parallel screws pose significant risk at all ages, while oblique screws appear significantly safer in all but the youngest children.

Mentions: For the classic, parallel screw, the risk of physeal breach was high (50% to 77%) in all groups (mean, 64%) and significantly increased with increasing age (χ2 = 9.8, P < .05) (Figure 4). For the novel 45° distally oblique screw, either joint penetration or physeal breach occurred in 13% of patients. Quartile ranges revealed children in the first quartile (<9 years 9 months of age) were at a much higher risk than older children (48% vs <3%; χ2 = 55, P < .001).


A Magnetic Resonance Imaging Study of the Significance of the Distal Femoral Physis During Medial Patellofemoral Ligament Reconstruction.

Greenrod W, Cox J, Astori I, Baulch J, Williams J - Orthop J Sports Med (2013)

Risk of physeal breach or joint penetration by age quartiles and screw direction. Note that parallel screws pose significant risk at all ages, while oblique screws appear significantly safer in all but the youngest children.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4555493&req=5

fig4-2325967113502638: Risk of physeal breach or joint penetration by age quartiles and screw direction. Note that parallel screws pose significant risk at all ages, while oblique screws appear significantly safer in all but the youngest children.
Mentions: For the classic, parallel screw, the risk of physeal breach was high (50% to 77%) in all groups (mean, 64%) and significantly increased with increasing age (χ2 = 9.8, P < .05) (Figure 4). For the novel 45° distally oblique screw, either joint penetration or physeal breach occurred in 13% of patients. Quartile ranges revealed children in the first quartile (<9 years 9 months of age) were at a much higher risk than older children (48% vs <3%; χ2 = 55, P < .001).

Bottom Line: Results are plotted against age and compared as quartile ranges.The femoral insertion of the MPFL was found to be distal to the distal femoral physis in all patients by an average of 10 mm (range, 2-16 mm).However, in children older than 10 years, a 20-mm screw, from the anatomic MPFL insertion and directed 45° distally oblique, should be safe in 98% of patients.

View Article: PubMed Central - PubMed

Affiliation: Mater Children's Hospital, Brisbane, Queensland, Australia. ; School of Medicine, University of Queensland, Brisbane, Queensland, Australia.

ABSTRACT

Background: Medial patellofemoral ligament (MPFL) reconstruction in adults often utilizes screw fixation in the distal femur. The aim was to define the safety of similar fixation in young patients, with respect to their open physis.

Purpose: To define the age-related relationship between the femoral insertion of the MPFL and the medial aspect of the distal femoral physis on magnetic resonance imaging (MRI) scans. The study investigates whether screw fixation at this point is safe with respect to patient age and screw inclination.

Study design: Cross-sectional study.

Methods: Retrospective review of the MRI scans of 159 skeletally immature patients. The femoral insertion of the MPFL was defined with respect to the distal femoral physis. The predicted paths of 2-cm screw fixation were simulated both parallel to the joint line and 45° distally oblique; physeal and joint penetration were noted when present. Results are plotted against age and compared as quartile ranges.

Results: The femoral insertion of the MPFL was found to be distal to the distal femoral physis in all patients by an average of 10 mm (range, 2-16 mm). The mean distance increases slightly with age in a nonlinear relationship (r = 0.51, P < .001) from 9 mm at age 10 years to 12 mm by age 16 years. For the classic, parallel screw, the risk of physeal breach is high for all age groups (mean, 64%). For the novel, oblique screw, joint penetration and physeal breach were less prevalent (mean, 13%), and importantly, the vast majority of these breaches were in younger children (age <9 years 9 months). With oblique screws, older children were at significantly lower risk than younger children (<3% vs 48%; P < .001).

Conclusion: This study accurately defines the relationship between the femoral insertion of the MPFL and the distal femoral physis in children and adolescents. A high risk of potentially poor outcomes was found during anatomic reconstruction of the MPFL in children utilizing classic (parallel) screw fixation, irrespective of age. However, in children older than 10 years, a 20-mm screw, from the anatomic MPFL insertion and directed 45° distally oblique, should be safe in 98% of patients.

No MeSH data available.