Acquired femoral flexion deformity due to physeal injury during medial patellofemoral ligament reconstruction

Abstract

Background: Reconstruction of the medial patellofemoral ligament (MPFL) is the most frequent surgical procedure performed in patients with patellar instability. Recently, concerns regarding physeal injury during femoral tunnel placement for anatomical MPFL reconstruction in children have been discussed.

Methods: This is the first case to report partial posterior physeal growth arrest and subsequent flexion deformity of the distal femur after MPFL reconstruction in a skeletally immature patient. The cause and treatment are discussed.

Results: Postoperative knee extension deficit and recurrent patellar instability were successfully treated with revision surgery including, distal femoral extension osteotomy, medialization of the tibial tuberosity, trochleoplasty and MPFL graft tensioning.

Conclusion: This case highlights that care should be taken during femoral tunnel placement for anatomic graft fixation to avoid physeal injuries in skeletally immature patients.

Keywords: Complication; Extension deficit; Flexion deformity; MPFL; Medial patellofemoral ligament reconstruction; Revision.