Quadruple Surgical Approach for Treating Lateral Habitual Patellar Dislocations in Children and Adolescents
Objective To explore the clinic effect of combined method of extensive lateral release,Z lengthening plasty of the lateral portion of quadricipital tendon,Roux-Goldthwait procedure(medial transplant of lateral half of the patella tendon)and single boundle reconstruction of medial patellofemoral ligament(MPFL)with adductor magnus tendon autograft for the treatment of habitual dislocation of patella(HDP)in children and adolescent.Methods From August 2016 to August 2019,a total of 13 skeletally immature patients(15 knees)with severe quadriceps contracture underwent the comprehensive surgical procedure.These included 3 male patients(3 knees)and 10 female patients(12 knees).The patients'ages ranged from 9 to 14 years old,with an average age of(11.6±1.8)years.Preoperatively,risk factors for dislocation such as patellofemoral joint development,tibial tubercle deviation,lower limb malalignment,degree of torsion deformity,and patellar height were evaluated and analyzed through knee X-rays,MRI,hip-knee-ankle CT scans,and full-length X-rays of both lower limbs.Clinical examinations and knee joint X-rays were conducted during the final follow-up visit.Changes in Lysholm scores,patellofemoral joint congruency angles,and lateral patellofemoral angles were evaluated and compared between pre-surgery and the final follow-up.Results No infection,graft rejection,or rupture was observed in any of the cases.The patients were followed up for 24～58 months(average:36.9±12.5 months).Lysholm scores significantly improved from(75.7±8.7)preoperatively to(94.6±5.7)(P＜0.05)at the final follow-up.X-ray measurements indicated excellent patella reduction,with no recurrence of dislocation or subluxation.There was a statistically significant improvement in the congruency angle,from(73.4±17.2)° preoperatively to(-7.4 ±4.6)°(P＜0.01),and in the lateral patellofemoral angle,from(-65.6±8.4)° preoperatively to(6.7±3.5)°(P＜0.01),at the final follow-up.Two patients experienced poor wound healing but healed well after regular dressing changes.Conclusion In this mid-term study,the novel quadruple procedure,comprising extensive lateral release,Z-lengthening plasty of the lateral portion of the quadriceps tendon,the Roux-Goldthwait procedure(medial transplantation of the lateral half of the patella tendon),and single-bundle reconstruction of the MPFL using autograft from the adductor magnus tendon,was found to be effective in treating lateral HDP in skeletally immature patients with severe quadriceps contracture.
NETL
NSTL
万方数据
