The Three-In-One Proximal and Distal Soft Tissue Patellar Realignment Procedure

Abstract

The three-in-one procedure for extensor mechanism realignment of the knee combines lateral release, vastus medialis obliquus muscle advancement, and transfer of the medial one-third of the patellar tendon to the tibial collateral ligament. We observed 37 patients (42 knees) receiving this treatment at a minimum 25-month follow-up (range, 25 to 85 months; mean, 44). Thirty-two of 42 knees (76%) with recurrent patellar dislocation had good or excellent results after surgery. Redislocation occurred in four knees (9.5%). Skeletal immaturity, chondral damage, and generalized ligament laxity did not seem to affect outcome. Thirty patients (37 knees) were studied 2 years earlier as well (mean follow-up, 29 months). When comparing the results 2 years later, there was a significant deterioration in outcome over time. These results are comparable with the published results for other techniques of patellar stabilization. We describe the place of the three-in-one operation in our surgical protocol for patellofemoral instability, which is based on the principle that a procedure should be selected to address the underlying pathologic features in an individual case rather than always using one operation for all cases.

Medial patellotibial ligament (MPTL) reconstruction for patellar instability

“…The correlation of high BMI to worse symptoms at the pre-operative status confirms what reported in the literature, as high values of BMI have been reported to be associated with higher strains on the articular cartilage of medial and lateral compartments [34], increased prevalence of patella cartilage defects [14] and increased rates of patellofemoral arthritis [20,21]. Moreover, worse results in term of post-operative sport participation were obtained in patients with severely dysplastic knees.…”

Trochlear osteotomy for patellar instability: satisfactory minimum 2-year results in patients with dysplasia of the trochlea

“…In our opinion early stabilisation of the patella may prevent further patellofemoral cartilage damage and therefore patellofemoral osteoarthritis [14]. Our medium-term results show little progression of radiologic changes.…”

“…The incidence of a cartilage damage after a patella dislocation has been estimated to be as high as 8.4% [19]. In our opinion early stabilisation of the patella may prevent further patellofemoral cartilage damage and therefore patellofemoral osteoarthritis [14]. Our medium‐term results show little progression of radiologic changes.…”

Complications of Patello-Femoral Joint Surgery

“…A "three-in-one" procedure was reported in 42 knees for recurrent patellar dislocation by Myers et al 23 LRR, VMA, and transfer of the medial 1/3 of the patella tendon to the MCL was performed and followed for nearly 4 years. The authors prefer to use the medial 1/3 of the patella instead of the lateral 1/3 (Roux-Goldthwait procedure) to avoid iatrogenic lateral patellar tilt.…”