{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T23:34:29Z","timestamp":1793230469637,"version":"4.5.0"},"reference-count":36,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2019,3,9]],"date-time":"2019-03-09T00:00:00Z","timestamp":1552089600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2019,3,9]],"date-time":"2019-03-09T00:00:00Z","timestamp":1552089600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The purpose of this study was to assess the physeal safety associated with the use of an epiphyseal femoral socket for paediatric medial patellofemoral ligament (MPFL) reconstruction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Fifty\u2010four knees in 49 skeletally immature patients underwent physeal\u2010sparing MPFL reconstruction performed by 1 surgeon at a tertiary care academic medical centre from 2007 to 2016. A femoral socket distal to the femoral physis was used for graft fixation in all the patients. To assess physeal safety, all included patients either had post\u2010operative MRIs of the operative knee or standing hip\u2010to\u2010ankle radiographs. Physeal safety was assessed on MRI, and the distance between the femoral socket relative to the physis was measured at both the aperture and the end of the socket. Development of lower limb angular deformities and\/or limb length discrepancy (LLD) was evaluated using post\u2010operative standing hip\u2010to\u2010ankle radiographs, patient records, and clinical assessments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean age at time of surgery was 13.3\u2009\u00b1\u20091.6 years. The median length of radiographic follow\u2010up was 2.2 years (range 1.0\u20135.7 years). At most recent clinical follow\u2010up, five patients (9.3%) had recurrent patellar instability, with three patients (5.6%) undergoing subsequent tibial tubercle osteotomy or revision MPFL reconstruction. There was no statistically significant difference in leg length between operated and non\u2010operated extremities (n.s.). There was no statistically significant difference between non\u2010operated and operated mMPTA (n.s.) and mLDFA (n.s.) measurements. On post\u2010operative MRI, there was no evidence of physeal arrest. The median distance from the physis to the socket at the aperture and distal end of the femoral socket were 5.9\u00a0mm (range 1.9\u201312) and 7.1\u00a0mm (1.3\u201312.4), respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These results demonstrate that with fluoroscopic guidance, placing the femoral socket distal to the distal femoral physis is an effective method for avoiding physeal injury and subsequent growth disturbances in children with patellar instability. Clinically, this information is essential in optimal surgical management of these patients, as this technique allows for femoral fixation of the MPFL reconstruction graft within the epiphysis while also preserving normal growth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Level IV\u2014case series.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-019-05412-7","type":"journal-article","created":{"date-parts":[[2019,3,9]],"date-time":"2019-03-09T01:12:26Z","timestamp":1552093946000},"page":"3536-3542","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["Medial patellofemoral ligament (MPFL) reconstruction technique using an epiphyseal femoral socket with fluoroscopic guidance helps avoid physeal injury in skeletally immature patients"],"prefix":"10.1002","volume":"27","author":[{"given":"Tyler 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USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Haskel","sequence":"additional","affiliation":[{"name":"<!--<label>3<\/label>--> Robert Wood Johnson Medical School 675 Hoes Lane West 08854 Piscataway NJ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel W.","family":"Green","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Hospital for Special Surgery 525 E 70th Street 10021 New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,3,9]]},"reference":[{"key":"e_1_2_8_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0278\u20105919(02)00031\u20105"},{"key":"e_1_2_8_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199312000-00004"},{"key":"e_1_2_8_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2018.05.004"},{"key":"e_1_2_8_5_2","first-page":"139","article-title":"Medial patellofemoral ligament (MPFL) 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April 2018","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 February 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 March 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Dr. Daniel Green is a consultant for Arthrex and receives Royalties from Arthrex and Pega Medical. The remaining authors have nothing to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study received institutional review board (IRB) approval from Hospital for Special Surgery (IRB# 14082).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}