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Diagnostic Arthroscopy for Identifying Patellofemoral Chondral Lesions Missed by MRI in Pediatric Patients Undergoing MPFLR

Year: 2025

Type: article

Abstract: Background: Patellofemoral dislocations are often associated with chondral injuries. In adults, diagnostic arthroscopy (DA) has identified chondral injuries in up to one-third of cases where magnetic resonance imaging (MRI) was negative. However, the value of DA in detecting cartilage injuries in pediatric patients undergoing medial patellofemoral ligament reconstruction (MPFLR) has not been well studied. Purposes: To evaluate the utility of DA in diagnosing cartilaginous injuries in pediatric patients undergoing MPFLR with negative preoperative MRI findings and to compare postoperative outcomes between patients with and without chondral injury findings on DA. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A retrospective review was conducted on patients aged 0 to 18 years who underwent combined MPFLR and DA procedures from 2015 to 2023 at a single institution. The exclusion criteria were as follows: revision MPFLR; tibial tubercle osteotomy; multiligament reconstructions; and previous meniscal injury. MRI and DA reports were reviewed for chondral findings. Patients were classified into 3 groups: +MRI/+DA, –MRI/+DA, and –MRI/–DA. Subgroup analysis was performed within the –MRI/+DA group to compare outcomes in the immediate postoperative recovery period between those who underwent a chondroplasty versus those who did not. Results: Of the 155 patients included, follow-up averaged 7.8 months (median, 5 months [range, 0-41 months]). Among 89 patients with negative MRI findings, 39 (43.8%) had chondral injuries detected on DA. Targeted treatment was performed in 22 (56.4%) of these patients, a lower rate than in those with positive MRI findings (80.3%; P = .02). No significant differences were observed in knee flexion at 2 weeks postoperatively: +MRI/+DA (77.9°± 23°), –MRI/+DA (66.5°± 30.2°), and –MRI/–DA (73.3°± 30°) ( P = .14). Similarly, no significant differences were found at 12 weeks: +MRI/+DA (135.3°± 13°), –MRI/+DA (127.8°± 21°), and –MRI/–DA (134.1°± 13.4°) ( P = .10). Range of motion and complication rates were comparable across all groups ( P > .05). A subgroup analysis in the –MRI/+DA cohort comparing patients who underwent an arthroscopic procedure (n = 22) with those who did not (n = 17) showed no significant differences in range of motion or complication rates ( P > .05). Conclusion: Diagnostic arthroscopy detected cartilaginous injuries in 43.8% of pediatric patients with negative preoperative MRI undergoing MPFLR. This highlights the diagnostic value of DA in identifying injuries that would otherwise remain undetected.

Source: Orthopaedic Journal of Sports Medicine

DOI: 10.1177/23259671251389130