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Child Orthopedics
Spine - Cervical
Spine - Lumbar
Spine - Thoracic

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Our 23-year-old son is still on our insurance policy (until he is 26) so we know a lot about his medical problems. He was a high school and college athlete who ended up with a bum knee. Last year he had an operation to reattach the ligament along the inside of the knee to the knee cap. It evidently didn't do the trick because he ended up with a very stiff knee. Now they are talking about doing a knee manipulation. Poor guy. Does this happen very often?

It sounds like he had a medial patellofemoral ligament (MPFL) reconstructive surgery. The surgeon uses graft tissue (usually a tendon from a donor bank or from some other area of the patient's own body) to reattach the ligament. The goal is to reduce pain, stabilize the patellofemoral joint (where the knee cap rides up and down over the thigh bone), and prevent patellar dislocation. There are many different ways to accomplish this and no one way known to have the best results for everyone. Researchers are currently looking at results reported for different graft choices, graft tension, and fixation methods (ways to attach the graft in place). This type of information will help surgeons find better ways to stabilize the knee and prevent a disabling condition for these young athletes. Complications are reportedly fairly high following this particular procedure. In a recent review of studies, researchers found a complication rate of 26.1 per cent. This figure represents an overall complication rate from all the studies combined. The procedure was a success but the complication rate was considered significant. Rates actually ranged from zero (no complications) up to 85 per cent. Taking a closer look at the specific complications, there were patellar fractures, patellar instability, loss of knee motion, pain, infection, and other wound complications. The most common revision surgeries were to remove bothersome hardware or manipulate (move) stiff knees to restore motion. It is believed that tensioning the graft too tightly may be the cause of the stiff knees. With more study to identify the best ways to reconstruct damaged MPFLs, this complication may be prevented in the future.


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