Abstract
PurposeIn this study, the functional mid-term outcomes of the modified Grammont and Langenskiöld technique was assessed in skeletally immature patients with habitual patellar dislocation, with emphasis on knee function, pain, and other possible post-surgical complications. This is the first study concerning the application of the modified Grammont and Langenskiöld technique in habitual patellar dislocations.MethodsThis retrospective cohort study considered 10 patients (15 knees), ranging from 7 to 11 years old, who underwent the modified Grammont and Langenskiold procedure between 2015 and 2018. History of dislocation, patellar stability and range of motion (ROM) were analysed. To assess functional improvement and knee pain, the Kujala Anterior Knee Pain Scale and KOOS-Child Knee Survey were used before and after surgical treatment.ResultsNo history of dislocation was noted after surgical treatment. All 15 knees showed full ROM. There were no signs of genu recurvatum and no length discrepancies were found. The subjective assessment revealed significant improvement in the scores of the KOOS-Child questionnaire in all five sections (p < 0.001), as well as in The Kujala Anterior Knee Pain Scale (p = 0.001).ConclusionThe modified Grammont and Langenskiöld technique yields remarkable results in terms of knee stability and knee function, while decreasing recurrence risk and intensity of pain in patients with challenging cases of patellofemoral joint dislocation. This surgical technique is most effective in cases where the patella remains dislocated continuously; however, it may also be used in immature patients with recurrent instability.Level of evidenceIV.
Highlights
Habitual patellar dislocation in children is considered an orthopedic condition which is challenging to treat due to its complexity
There are several elements in this pathology which need to be addressed if one would like to achieve a positive outcome of treatment
Conservative treatment is partially effective in patients with primary or recurrent patellar dislocation, this is inadequate in cases of habitual dislocation, whereby surgical procedures are more effective [1]
Summary
Habitual patellar dislocation in children is considered an orthopedic condition which is challenging to treat due to its complexity. There are several elements in this pathology which need to be addressed if one would like to achieve a positive outcome of treatment These include patellar dislocation, trochlear groove dysplasia, tibial tuberosity lateralization, medial capsule elongation, and lateral capsule. A combination of procedures involving proximal and distal reconstruction is recommended [2, 10, 15] In their original versions, the Grammont and Langenskiöld procedures both require complete detachment of the distal insertion of the patellar ligament, and reattachment towards the medial position. The Grammont and Langenskiöld procedures both require complete detachment of the distal insertion of the patellar ligament, and reattachment towards the medial position This may significantly disturb the growth of the tibial tuberosity and slow down the process of postoperative rehabilitation [10, 15]. The functional and radiographic outcomes of this technique in skeletally immature patients were reported
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