Evaluation of the Modified Elmslie-Trillat Procedure for Patellofemoral Dysfunction

Abstract

The goal of this study was to evaluate the Elmslie-Trillat procedure for recurrent patellar dislocation, patellofemoral pain (with extensor mechanism malalignment), or a combination of both. Thirty-two patients underwent the modified Elmslie-Trillat procedure, consisting of a lateral retinacular release and medialization of the tibial tuberosity for recurrent patellar dislocation, patellofemoral pain, or both. Twenty-nine of 32 patients were available for follow-up. All patients were evaluated clinically and radiologically. Subjective scores were evaluated using the Cox grading system and objective scores using Fulkerson's functional knee score. Average patient age was 33 years. Mean follow-up was 45 months. Subjectively, using the Cox grading system, 10 patients (34%) had an excellent result, 8 (28%) had a good result, 8 (28%) had a fair result, and 3 (10%) had a poor result. All patients with patella dislocation had an excellent or good subjective result, while only 3 patients (34%) with the primary symptom of patellofemoral pain with extensor mechanism malalignment and 4 patients (44%) with a combination of both symptoms had a good or excellent result. Mean Fulkerson's functional knee score was excellent for patients with dislocation only, and fair for those with only pain or both pain and dislocation. The congruence angle was corrected in all patients with this technique. There were no further dislocations in our series. Two patients required hardware removal. The Elmslie-Trillat procedure is a good surgical option for treatment of recurrent patella instability following failed conservative therapy. However, the results are not as favorable for patients with patellofemoral pain without instability.