Galeazzi semitendinosus tenodesis for patellofemoral instability in skeletally immature patients.

BACKGROUND: Numerous surgical treatments have been described to address subluxation or dislocation of the patella, but many are not suitable for the skeletally immature patient, as they risk injury to the proximal tibial physis or tibial tubercle apophysis. The Galeazzi semitendinosus tenodesis is a soft-tissue reconstruction technique designed to stabilize the patella without altering the femoral or the bony structures about the knee. We sought to determine if this semitendinosus tenodesis is a safe and effective treatment for patellofemoral instability in skeletally immature patients.
METHODS: We retrospectively analyzed the records of a population of skeletally immature patients who underwent semitendinosus tenodesis for patellofemoral instability at our institution from 1990 to 2006. Condition-specific outcome and function were prospectively collected, including the International Knee Documentation Committee (IKDC) score, Kujala Score, and Marx Activity Scale. Recurrent instability was defined as patient-reported postoperative subluxation, dislocation, or both.
RESULTS: Twenty-eight patients (34 total knees) were included in the study. Average follow-up was 70 months (range, 27 to 217 mo). Patients reported recurrent instability in 28 of the 34 knees (82%). Overall, 41% of patients had IKDC scores <70. Twelve knees (35%) were symptomatic enough to undergo subsequent surgery, but had similar mean IKDC (63), Kujala (81), and Marx Activity Scores (7.5) at long-term follow-up to those (IKDC 64, Kujala 79, Marx 8.2) who did not undergo additional surgeries (P=0.73, 0.88, 0.76, respectively). Complications included 1 superficial wound infection and 1 mild wound dehiscence.
CONCLUSIONS: Patellofemoral instability remains a challenging clinical problem, particularly in patients with open physes. The Galeazzi semitendinosus tenodesis is a safe procedure for patellofemoral instability in skeletally immature patients, but our long-term data suggest it may not be as successful as previously reported. Approximately 82% of patients experienced recurrent subluxation or dislocation despite surgical intervention, which may be due in large part to various predisposing factors, and there was a 35% rate of second surgeries. However, given the variability in techniques and reported results of patellofemoral stabilizing procedures in skeletally immature patients, the Galeazzi procedure may still be a reasonable way to temporize the difficult problem of patellar instability until patients reach skeletal maturity, when bony realignment procedures can be more safely used. LEVEL OF EVIDENCE: Level IV, case series.