Muharrem İNAN, İlker Abdullah SARIKAYA, Ali ŞEKER, Kubilay BENG

A combined procedure for irreducible dislocation of patella in children with ligamentous laxity: a preliminary report

Objective: Irreducible patellar dislocation accompanying ligamentous laxity is rarely seen in pediatric patients. The most common complaints due to this condition are inability to walk, delayed walking, and difficulties with orthotics. The purpose of this retrospective study is to describe a novel surgical technique to treat dislocated patella in patients with symptomatic ligamentous laxity.Methods: Fourteen knees of 9 patients operated on by a single surgeon between 2009-2012 were included in the study. The tensor fascia was divided into 2 strips, and these strips were passed via the joint and sutured to themselves. The combined procedure additionally includes lateral capsular release, vastus lateralis (VL) resection, medial capsular plication, and Z-plasty of the rectus femoris (RF) tendon.Results: Mean age at the time of surgery was 6.9±3.3 years (range: 4-13 years). The mean follow-up was 37.6±0.9 months (range: 26-49 months). Patellofemoral instability was restored for all patients by using combined surgical technique. Patellar lateralization developed in 2 patients, in whom stability was obtained via secondary medial plication.Conclusion: Our results show that this combined surgical procedure stabilizes the knee and treats patellar dislocation accompanying ligamentous laxity in pediatric patients

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Bettuzzi C, Lampasi M, Magnani M, Donzelli O. Surgical treatment of patellar dislocation in children with Down syndrome: a 3- to 11-year follow-up study. Knee Surg Sports Traumatol Arthrosc 2009;17:334-40.

Dugdale TW, Renshaw TS. Instability of the patello- femoral joint in Down syndrome. J Bone Joint Surg Am 1986;68:405-13.

Swaroop VT, Dias L. Orthopedic management of spina bifida. Part I: hip, knee, and rotational deformities. J Child Orthop 2009;3:441-9.

Paton RW, Bonshahi AY, Kim WY. Congenital and irre- ducible non-traumatic dislocation of the patella--a modi- fied soft tissue procedure. Knee 2004;11:117-20.

Ghanem I, Wattincourt L, Seringe R. Congenital disloca- tion of the patella. Part I: pathologic anatomy. J Pediatr Orthop 2000;20:812-6.

Goldthwait JE. Slipping or recurrent dislocation of the patella: with the report of eleven cases. American Journal of Orthopedic Surgery, Vol. 1, pp. 293-308, 1903. J Bone Joint Surg Am 2003;85-A:2489.

Gordon JE, Schoenecker PL. Surgical treatment of congenital dislocation of the patella. J Pediatr Orthop 1999;19:260-4.

Jones RD, Fisher RL, Curtis BH. Congenital dislocation of the patella. Clin Orthop Relat Res 1976;119:177-83.

Langenskiöld A, Ritsilä V. Congenital dislocation of the patella and its operative treatment. J Pediatr Orthop 1992;12:315-23.

Gao GX, Lee EH, Bose K. Surgical management of con- genital and habitual dislocation of the patella. J Pediatr Orthop 1990;10:255-60.

Ghanem I, Wattincourt L, Seringe R. Congenital dislo- cation of the patella. Part II: orthopaedic management. J Pediatr Orthop 2000;20:817-22.

Wada A, Fujii T, Takamura K, Yanagida H, Surijamorn P. Congenital dislocation of the patella. J Child Orthop 2008;2:119-23.

Krackow KA, Thomas SC, Jones LC. A new stitch for lig- ament-tendon fixation. Brief note. J Bone Joint Surg Am 1986;68:764-6.

Diamond LS, Lynne D, Sigman B. Orthopedic disorders in patients with Down's syndrome. Orthop Clin North Am 1981;12:57-71.

Livingstone B, Hirst P. Orthopedic disorders in school children with Down's syndrome with special reference to the incidence of joint laxity. Clin Orthop Relat Res 1986;207:74-6.

Ramaswamy R, Kosashvili Y, Murnaghan JJ, Yau CK, Cameron JC. Bilateral rotational osteotomies of the proxi- mal tibiae and tibial tuberosity distal transfers for the treatment of congenital lateral dislocations of patellae: a case report and literature review. Knee 2009;16:507-11.

Williams JJ, Graham GP, Dunne KB, Menelaus MB. Late knee problems in myelomeningocele. J Pediatr Orthop 1993;13:701-3.

Stanisavljevic S, Zemenick G, Miller D. Congenital, irre- ducible, permanent lateral dislocation of the patella. Clin Orthop Relat Res 1976;116:190-9.

Conn HR. A new method of operative reduction for congenital luxation of the patella. J Bone Joint Surg 1925;7:370.

Eilert RE. Congenital dislocation of the patella. Clin Or- thop Relat Res 2001;389:22-9.

Green JP, Waugh W, Wood H. Congenital lateral disloca- tion of the patella. J Bone Joint Surg Br 1968;50:285-9.

Hung NN. Using an iliotibial tract for patellar dislocation in children. J Child Orthop 2008;2:343-51.

Camathias C, Rutz E, Götze M, Brunner R, Vavken P, Gaston MS. Poor outcome at 7.5 years after Stanisavljevic quadriceps transposition for patello-femoral instability. Arch Orthop Trauma Surg 2014;134:473-8.

Lattermann C, Lobenhoffer P. Biomechanical changes in the hip, femur and knee joint after removal of a tensor fas- ciae latae flap. [Article in German] Handchir Mikrochir Plast Chir 1996;28:76-82. [Abstract]

Kolowich PA, Paulos LE, Rosenberg TD, Farnsworth S. Lateral release of the patella: indications and contraindica- tions. Am J Sports Med 1990;18:359-65.

Deie M, Ochi M, Sumen Y, Yasumoto M, Kobayashi K, Kimura H. Reconstruction of the medial patellofemoral ligament for the treatment of habitual or recurrent dis- location of the patella in children. J Bone Joint Surg Br 2003;85:887-90.

Grannatt K, Heyworth BE, Ogunwole O, Micheli LJ, Ko- cher MS. Galeazzi semitendinosus tenodesis for patello- femoral instability in skeletally immature patients. J Pedi- atr Orthop 2012;32:621-5.

Letts RM, Davidson D, Beaule P. Semitendinosus teno- desis for repair of recurrent dislocation of the patella in children. J Pediatr Orthop 1999;19:742-7.

Lemaire M. Chronic knee instability. Technics and results of ligament plasty in sports injuries. [Article in French] J Chir (Paris) 1975;110:281-94. [Abstract]

Marcacci M, Zaffagnini S, Marcheggiani Muccioli GM, Neri MP, Bondi A, Nitri M, et al. Arthroscopic intra- and extra-articular anterior cruciate ligament reconstruction with gracilis and semitendinosus tendons: a review. Curr Rev Musculoskelet Med 2011;4:73-7.

Pearl AJ, Bergfeld JA, editors. Extraarticular reconstruc- tion in the anterior cruciate ligament deficient knee. Champaign: Human Kinetics Books; 1992.

Kennedy A, Coughlin DG, Metzger MF, Tang R, Pearle AD, Lotz JC, et al. Biomechanical evaluation of pediatric anterior cruciate ligament reconstruction techniques. Am J Sports Med 2011;39:964-71.

Scott WN, Schosheim PM. Intra-articular transfer of the iliotibial muscle-tendon unit. Clin Orthop Relat Res 1983;172:97-101.

Bensahel H, Souchet P, Pennecot GF, Mazda K. The un- stable patella in children. J Pediatr Orthop B 2000;9:265- 70.

Bergman NR, Williams PF. Habitual dislocation of the patella in flexion. J Bone Joint Surg Br 1988;70:415-9.

Hung NN, Tan D, Do Ngoc Hien N. Patellar dislocation due to iatrogenic quadriceps fibrosis: results of operative treatment in 54 cases. J Child Orthop 2014;8:49-59.

Jackson AM, Hutton PA. Injection-induced contractures of the quadriceps in childhood. A comparison of proximal release and distal quadricepsplasty. J Bone Joint Surg Br 1985;67:97-102.

Aglietti P, Insall JN, Cerulli G. Patellar pain and incon- gruence. I: Measurements of incongruence. Clin Orthop Relat Res 1983;176:217-24.