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Long-term outcome of surgically-treated habitual patellar dislocation in children with coexistent patella alta

MINIMUM FOLLOW-UP OF 11 YEARS

¹ Department of Surgery, University Hospitals of Geneva, Henri-Veyrassat 3, 1202 Geneva, Switzerland.
² University of Montreal, Division of Orthopaedic Surgery, H`pital du Sacré Coeur, 5400 Gouin Ouest, Local J-3245, Montreal, Quebec, Canada.
³ University of Montreal, Division of Orthopaedic Surgery, Hôpital Ste-Justine, 3175 Cote Ste-Catherine, Montreal, Quebec, Canada.

Correspondence should be sent to Dr G. Y. Laflamme; e-mail: orthofac{at}videotron.ca

We retrospectively reviewed the operative treatment carried out between 1988 and 1994 of eight patients with habitual patellar dislocation. In four the condition was bilateral. All patients had recurrent dislocation with severe functional disability. The surgical technique involved distal advancement of the patella by complete mobilisation of the patellar tendon, lateral release and advancement of vastus medialis obliquus. The long-term results were assessed radiologically, clinically and functionally using the Lysholm knee score, by an independent observer.

The mean age at operation was 10.3 years (7 to 14) with a mean follow-up of 13.5 years (11 to 16). One patient required revision. At the latest follow-up, all patellae were stable and knees functional with a mean Lysholm knee score of 98 points (95 to 100). In those aged younger than ten years at operation there was a statistically significant improvement in the sulcus angle at the latest follow-up (Student’s t-test, p = 0.001). Two patients developed asymptomatic patella infera as a late complication.

This technique offers a satisfactory treatment for the immature patient presenting with habitual patellar dislocation associated with patella alta. If performed early, we believe that remodelling of the shallow trochlea may occur, adding intrinsic patellofemoral stability.

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				S. Y. Joo, K. B. Park, B. R. Kim, H. W. Park, and H. W. Kim 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 J Bone Joint Surg Br, December 1, 2007; 89-B(12): 1645 - 1649. [Abstract] [Full Text] [PDF]