Double modified Hauser procedure: a long-term follow-up

Abstract

A long-term follow-up of 20 patients (23 knees) who had undergone the double modified Hauser (DMH) procedure was conducted. This procedure, a modification of a previously reported distal patellar realignment procedure 1, consists of medial and proximal implantation of the tibial tubercle to correct abnormal tracking with simultaneous anterior advancement (Maquet principle) to reduce contact pressures. All but two patients had undergone failed surgeries in the past and required operative intervention because of repeated patellar dislocations with severe anterior knee pain or, in five cases, severe pain due to advanced patellofemoral arthrosis. At an average follow-up of 11.6 years, 16 20 patients were satisfied with the result, two were unsure and two were dissatisfied. Recurrent dislocations occurred in four patients. At rest, 11 23 knees were occasionally painful, while 20 knees were occasionally painful when walking. Of 20 knees X-rayed, degenerative changes were found in 12, of which five had undergone patellectomy for intractable anterior knee pain. While this procedure is not recommended as a primary operation to correct tracking, the authors feel it offers theoretical advantages over the Maquet procedure for salvage purposes when arthroscopic lateral release has failed.