The results of the operative treatment of patellar instability in children with Down’s syndrome

Abstract

Patellar instability can significantly influence the locomotor function in children with Down's syndrome. The aim of this study was to evaluate the mid-term results of the operative treatment of patellar instability in children with Down's syndrome. The study included eight children (10 operated knees) with Down's syndrome and associated patellar instability. The children's age ranged from 6 to 11 years (the mean age was 7 years 9 months). The operative treatment involved Green's quadricepsplasty in six cases (eight knees) and Green's quadricepsplasty augmented with a modified Galeazzi procedure - semitendinosus tenodesis - in two cases. The mean follow-up period was 3 years and 3 months. We achieved a stabilization of the patellofemoral joint and a correction of the position of the patella in seven knees (five of these were treated with Green's procedure and in two cases Green quadricepsplasty was combined with the Galeazzi procedure). We did not observe any recurrence of patellar dislocation in this group during the follow-up period. We noted two failures, defined as a recurrence of dislocation, during the mean of 9 months postoperatively. Green's quadricepsplasty provides satisfactory results in younger children with Down's syndrome. In older children, we recommend the modified Galeazzi procedure.

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

“…The management of Down patients’ is often very demanding because postoperative management and compliance to treatment in this group is difficult. Moreover, it should be emphasized that children with Down's syndrome usually have a greater degree of instability, and in our opinion, they should not be considered and managed as standard cases 17…”

“…Down syndrome is one of the most common chromosomal abnormalities, consisting of a trisomy of chromosome 21; it is associated with many orthopedic manifestations such as atlanto-occipital and cervical instability, scoliosis, hip instability, slipped capital femoral epiphysis, patellar instability, and foot deformities 1117…”

“…In literature, there are few studies focusing on the management of patellar instability in Down syndrome. The Green's quadriceps plasty17 and a modified Roux-Goldthwait12 were used showing good results. Recently, a modified Stanisavljevic procedure was described in a group of patients with fixed or obligatory dislocation showing interesting results either in the subgroup affected by Down syndrome 19…”

“…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.…”

Good outcomes of modified Grammont and Langenskiöld technique in children with habitual patellar dislocation

“…As a result, this has led many authors to search for an effective, yet simple method of realignment of the patellofemoral joint. When used separately, the proximal and distal realignment techniques have been ineffective in the management of habitual dislocation of the patella [ 8 , 13 ]. Therefore, a combination of procedures involving proximal and distal reconstruction is recommended [ 2 , 10 , 15 ].…”