Patellar dislocation due to iatrogenic quadriceps fibrosis: Results of operative treatment in 54 cases

Abstract

ObjectiveTo evaluate the clinical and functional results of a surgical treatment of patellar dislocation whose etiology was iatrogenic quadriceps fibrosis in children.Materials and methodsA prospective study was undertaken from February 2004 to December 2009. The study included 54 pediatric patients (56 knees) that had developed dislocation of the patella after repeated intramuscular injections of antibiotic(s) into the quadriceps muscle. There were 11 males (20.4 %) and 43 females (79.6 %). The patients’ mean age at surgery was 7 years, 9 months (range 6 years, 4 months to 12 years, 6 months). A complete history of each patient was recorded. The affected knees were evaluated preoperatively and postoperatively on the basis of the symptoms, signs, and roentgenographic findings. Patellar dislocation was classified according Bensahel’s criteria. All patients had a three-part surgical procedure that combined capsulorrhaphy, quadricepsplasty, and transfer of the vastus medialis oblique to the superior border of the patella.ResultsThere has been no poor postsurgical result or recurrence so far; we have noted an ugly scar in nine knees (16.1 %), limitation of the knee flexion in five knees (8.9 %), and loss of extension of 5 °–20 ° in four knees (7.1 %). Overall, we attained excellent results in 39 knees (69.7 %), good results in 13 knees (23.2 %), and fair results in four knees (7.1 %).ConclusionIn our cases of pediatric dislocation of the patella caused by iatrogenic quadriceps fibrosis, the introduced three-part surgical procedure has shown great success in restoring the realignment mechanism of the patella. The technique is simple, safe, and effective in skeletally immature children.

Surgical Technique for Obligate Flexion Patellar Dislocation: Medial Patellofemoral Ligament Reconstruction, Distal Femoral Osteotomy, Quadricepsplasty, and Lateral Retinacular Reconstruction with Dermal Allograft

“…21,22 Different approaches have been described to treat this component of obligate flexion patellar dislocation, including quadricepsplasty (e.g., Judet quadricepsplasty), proximal rectus femoris release, and the VY quadriceps tendon lengthening procedure. [2][3][4][5] For example, Hung et al 23 described performing a capsulorrhaphy, quadricepsplasty, and VM transfer. In this approach, they detach the insertion of the VL and VM from the patella and perform a tenotomy of the vastus intermedius, which is then sutured to the RF.…”

Modeling of active skeletal muscles: a 3D continuum approach incorporating multiple muscle interactions

“…In this study, we extended the 3D active muscle model presented above into a body system level with multiple lower extremity muscles ( Figure 4A ), aiming to examine the effectiveness and stability of simulating motion with multiple instances of the above presented pipeline for single active muscle modeling. Simulation of the quadriceps mechanism including the knee is important for the investigation of muscle pathologies and treatments that impact lower limb function, such as acute injury ( Puladi et al, 2022 ), fibrosis ( Hung et al, 2014 ), and sarcoma ( Houdek et al, 2021 ). To simulate active quadriceps, we have a baseline model of the right lower limb which included subject-specific bony structures and cartilages of the knee segmented from computed tomography (CT) and magnetic resonance imaging (MRI) ( Hume et al, 2019 ).…”

The Iliotibial Band Transfer Restores Extensor Function after Quadricepsplasty for Knee Stiffness

“…Next, dividing the vastus intermedius tendon at the musculotendinous junction, 5 cm above the patella. If knee flexion > 90˚ was not achieved, the rectus femoris was detached 2 cm above the superior border of the patella, two tendons, the vastus intermedius, and the rectus femoris, being sewn together according to Nguyen NH et al [6]. When the rectus femoris was lengthened or divided it was as a last resort for gaining flexion, because that procedure diminishes the power of extension of the knee postoperatively [29].…”

“…Quadriceps muscle retraction follows muscle adherences induced by intramuscular injections into the anterolateral aspect of the thigh during the newborn period and early childhood [2] [4]- [6]. The first overt signs appear by the age of 2 years.…”