M Letts1, D Davidson, P Beaule2. 1. Department of Surgery, Children's Hospital of Eastern Ontario, 401 Smyth Road, K1H 8L1, Ottawa, Ontario, Kanada. 2. Division of Orthopaedics, Children's Hospital of Eastern Ontario, University of Ottawa, Kanada.
Abstract
OBJECTIVES: Correction of recurrent dislocation of the patella in children using a semitendinosus tenodesis and a double breasting of the medial retinaculum. INDICATIONS: Recurrent lateral patellar sub- or dislocation in skeletally immature patient. Patella alta with recurrent subluxation of the patella. Patella dislocation in the presence of generalized ligmentous laxity. CONTRAINDICATIONS: Degenerative changes of the patellofemoral joint. Congenital dislocation of the patella. SURGICAL TECHNIQUE: First incision at the posterior aspect of the thigh: division of the semitendinosus at its musculotendinous junction. Its muscle belly is sutured to the semimembranosus. Second incision over the pes anserinus: the tendon is delivered through this wound. Third incision over the inferior pole of the patella: division of the lateral patellar retinaculum. Passing of the semitendinosus tendon through a drill hole in the patella from mediodistal to proximolateral and fixation at the proximal pole of the patella. Double breasting of the medial patellar retinaculum. RESULTS: Between 1990 and 1997, 29 children (5 boys, 24 girls) were operated for a recurrent patellar dislocation. Average age at surgery: 14 years and 3 months (7 years and 8 months to 17 years and 10 months). Preoperatively, pain was present in 19 out of 34 knees, ligamentous laxity in 13, a positive apprehension sign in 12, and a patellar hypermobility in 11. Average length of follow-up: 3 years and 2 months (1 year to 7 years and 2 months). Twenty-seven out of 34 knees were asymptomatic and the children returned to normal activities. Patellofemoral pain persisted in 7 children. A medial patellar subluxation occurred in 1 child. A medial release led to a good result.
OBJECTIVES: Correction of recurrent dislocation of the patella in children using a semitendinosus tenodesis and a double breasting of the medial retinaculum. INDICATIONS: Recurrent lateral patellar sub- or dislocation in skeletally immature patient. Patella alta with recurrent subluxation of the patella. Patella dislocation in the presence of generalized ligmentous laxity. CONTRAINDICATIONS: Degenerative changes of the patellofemoral joint. Congenital dislocation of the patella. SURGICAL TECHNIQUE: First incision at the posterior aspect of the thigh: division of the semitendinosus at its musculotendinous junction. Its muscle belly is sutured to the semimembranosus. Second incision over the pes anserinus: the tendon is delivered through this wound. Third incision over the inferior pole of the patella: division of the lateral patellar retinaculum. Passing of the semitendinosus tendon through a drill hole in the patella from mediodistal to proximolateral and fixation at the proximal pole of the patella. Double breasting of the medial patellar retinaculum. RESULTS: Between 1990 and 1997, 29 children (5 boys, 24 girls) were operated for a recurrent patellar dislocation. Average age at surgery: 14 years and 3 months (7 years and 8 months to 17 years and 10 months). Preoperatively, pain was present in 19 out of 34 knees, ligamentous laxity in 13, a positive apprehension sign in 12, and a patellar hypermobility in 11. Average length of follow-up: 3 years and 2 months (1 year to 7 years and 2 months). Twenty-seven out of 34 knees were asymptomatic and the children returned to normal activities. Patellofemoral pain persisted in 7 children. A medial patellar subluxation occurred in 1 child. A medial release led to a good result.
Entities:
Keywords:
Habitual patellar dislocation; Habitual patellar subluxation; Surgical treatment in adolescents; Tenodesis with semitendinosus