The ‘four-in-one’ procedure for habitual dislocation of the patella in children

Joo, So Young; Park, K. B.; Kim, B. R.; Park, H. W.; Kim, Hyun Woo

doi:10.1302/0301-620x.89b12.19398

Cited by 70 publications

(42 citation statements)

References 26 publications

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“…Reported unsatisfactory results range from 20% to 80%. 7 Furthermore, these procedures are invasive, have high complication rates and require extensive rehabilitation. 8e20 Selective hemiepiphyseodesis, where one or more physes are surgically closed at the medial distal femur or the proximal tibia, is a well described and accepted treatment for correcting primary and secondary genu valgum in pediatric patients.…”

Section: Introductionmentioning

confidence: 99%

Selective hemiepiphyseodesis for patellar instability with associated genu valgum

Kearney

Mosca

2015

Journal of Orthopaedics

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Section: Introductionmentioning

confidence: 99%

Selective hemiepiphyseodesis for patellar instability with associated genu valgum

Kearney

Mosca

2015

Journal of Orthopaedics

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“…Kocon et al 17 reported that good results of eight children affected by Down syndrome after Green's quadricepsplasty procedure. The MPFL has recently received increased attention as an important stabilizer of the patellofemoral joint and numerous studies in the literature describe effective anatomic repairs or reconstructions of this ligament 12021. Vavken et al 2 have recently shown with a systematic review that reconstruction of MPFL is the most effective management option in recurrent patellar instability in healthy pediatric and adolescent population as this surgical technique restores knee anatomy.…”

Section: Discussionmentioning

confidence: 99%

“…Chronic patellar instability in skeletally immature population has been widely investigated in the past decade, although its management remains challenging 1. Different surgical procedures have been described to treat patellar instability with variable outcomes 2.…”

Section: Introductionmentioning

confidence: 99%

Modified Roux-Goldthwait Procedure for Management of Patellar Dislocation in Skeletally Immature Patients with Down Syndrome

Ruzzini

Donati

Russo

et al. 2019

IJOO

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Background: Patellar instability is a common problem in Down syndrome patients since their childhood. Several treatment have been proposed, but relapses are frequent and not all surgeries are suitable for growing patients. The aim of the present study is to evaluate the clinical and radiographic outcomes of a modified Roux-Goldthwait technique, for the management of patellar instability in children with Down syndrome at minimum 5-year followup. Materials and Methods: 19 patients (23 knees) affected by Down syndrome surgically treated for patellar dislocation, between 2000 and 2012 were included in this study. The mean age of patients was 9.5 years (range 3.7 – 15 years) and had a Dugdale Grade III, IV, and V patellar dislocation. Trochlear groove dysplasia was present in 15 patients. Each patient was clinically evaluated considering relapse rate, pre- and postoperative range of motion (ROM), Kujala score, and modified Lysholm score. Radiographic examination was performed on standard X-ray considering patellar height, trochlear angle, and patellofemoral congruence angle. Results: The mean followup was 134 months (range 62–206 months). No case of relapse of dislocation was registered with an improved ROM (significant for knee extension, P < 0.05). The Kujala score showed significant improvement from a mean preoperative value of 39 ± 6.3 to a mean postoperative value of 92.7 ± 3.4 ( P < 0.05) at final followup such as the modified Lysholm score (from mean preoperative 55.6 ± 6.3 to mean postoperative of 94.2 ± 2.6). Radiographs performed at latest followup showed a tendency to normalization of all the parameters considered, with a restored patellofemoral congruence and trochlear groove shape and without signs of osteoarthritis. Conclusion: The present study showed that the Roux-Goldthwait procedure is a valid surgical option for the treatment of patellar dislocation in children with Down syndrome.

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“…Among them, a treatment algorithm focusing on quadriceps lengthening is mandatory to reduce the patella in deep knee flexion. 9 Skeletally mature patients who have suffered from lateral HPDs often show a more severe degree of quadriceps contracture. Usually, the patella is forcibly held in the midline, and it is impossible to flex the knee more than 30° to 40°, indicating that the degree of quadriceps contracture is more severe than that in children.…”

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confidence: 99%

Tibial Tubercle Proximalization: A Novel Technique to Lengthen the Extensor Mechanism in Skeletally Mature Patients With Lateral Habitual Patellar Dislocations

Song

Feng

Zhang

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background:A habitual patellar dislocation (HPD) is a rare condition in skeletally mature patients, especially for those with severe quadriceps contracture. Until now, no study has reported the effectiveness of tibial tubercle proximalization to lengthen the extensor mechanism in treating severe HPDs in skeletally mature patients.Purpose:To describe a novel comprehensive procedure that includes tibial tubercle proximalization, extensive lateral release, tibial tubercle medialization, and medial patellofemoral ligament (MPFL) reconstruction in treating severe HPDs in skeletally mature patients and to report its early clinical outcomes.Study Design:Case series; Level of evidence, 4.Methods:From January 2014 to May 2016, a total of 43 consecutive patients (47 knees) with HPDs were surgically treated at a single institution and were retrospectively reviewed. Among them, 11 skeletally mature patients (11 knees) with severe primary HPDs underwent the index comprehensive procedure. Results of patellar tracking were recorded preoperatively and at the final follow-up. The radiological assessment included radiographs in standard anteroposterior, true lateral, and axial views and computed tomography scans at full knee extension before surgery and at the final follow-up. Subjective patellofemoral function was evaluated with the Kujala functional score before the index procedure and at the final follow-up visit.Results:The 11 included patients were evaluated for a mean period of 34.9 months (range, 25-46 months). The mean knee flexion angle when the patella dislocated laterally was 25° (range, 10°-30°) preoperatively. Radiologically, there was a statistically significant improvement in the congruence angle, from 73.4° ± 17.0° preoperatively to –7.1° ± 5.8° postoperatively (P < .01) and in the lateral patellofemoral angle, from –65.6° ± 9.4° preoperatively to 6.1° ± 2.7° postoperatively (P < .01). The mean preoperative Kujala functional score was 42.9, and the mean postoperative Kujala functional score was 95.2 (P < .05). No patients reported a recurrence of patellar dislocation at the final follow-up visit.Conclusion:The novel comprehensive procedure, including tibial tubercle proximalization, extensive lateral release, tibial tubercle medialization, and MPFL reconstruction, effectively treated lateral HPDs in skeletally mature patients with severe quadriceps contracture.

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The ‘four-in-one’ procedure for habitual dislocation of the patella in children

Cited by 70 publications

References 26 publications

Selective hemiepiphyseodesis for patellar instability with associated genu valgum

Selective hemiepiphyseodesis for patellar instability with associated genu valgum

Modified Roux-Goldthwait Procedure for Management of Patellar Dislocation in Skeletally Immature Patients with Down Syndrome

Tibial Tubercle Proximalization: A Novel Technique to Lengthen the Extensor Mechanism in Skeletally Mature Patients With Lateral Habitual Patellar Dislocations

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