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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 12, 1645-1649.
doi: 10.1302/0301-620X.89B12.19398  
Copyright © 2007 by British Editorial Society of Bone and Joint Surgery
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The ‘four-in-one’ procedure for habitual dislocation of the patella in children

EARLY RESULTS IN PATIENTS WITH SEVERE GENERALISED LIGAMENTOUS LAXITY AND APLASIS OF THE TROCHLEAR GROOVE

S. Y. Joo, MD, Clinical Fellow1; K. B. Park, MD, Lecturer2; B. R. Kim, MD, Clinical Fellow1; H. W. Park, MD, Professor3; and H. W. Kim, MD, PhD, Associate Professor1

1 Department of Orthopaedic Surgery, Severance Children’s Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-Gu, Seoul 120-752, Korea.
2 Department of Orthopaedic Surgery, Hallym University College of Medicine, 896 Pyeongchon-Dong, Dongam-Gu, Anyang, Korea.
3 Department of Orthopaedic Surgery, Yongdong Severance Hospital, Yonsei University, College of Medicine, 612 Eonjuro, Kangnam-Gu, Seoul 135-720, Korea.

Correspondence should be sent to Professor H. W. Kim; e-mail: pedhkim{at}yuhs.ac.kr

We describe our experience with the ‘four-in-one’ procedure for habitual dislocation of the patella in five children (six knees). All the patients presented with severe generalised ligamentous laxity and aplasia of the trochlear groove. All had a lateral release, proximal ‘tube’ realignment of the patella, semitendinosus tenodesis and transfer of the patellar tendon. The mean age at the time of the operation was 6.1 years (4.9 to 6.9), and the patients were followed up for a mean of 54.5 months (31 to 66). The clinical results were evaluated using the Kujala score.

There has been no recurrence of dislocation. All the patients have returned to full activities and the parents and children were satisfied with the clinical results. The mean Kujala score was 95.3 (88 to 98). Two patients had marginal skin necrosis which healed after debridement and secondary closure. These early results in this small group have shown that the ‘four-in-one’ procedure is effective in the treatment of obligatory dislocation of the patella in children with severe ligamentous laxity and trochlear aplasia.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General