Management of Patellar Subluxation

Abstract

Patellar subluxation is one of the most common causes of internal derangement of the knee in young individuals. Most surgical techniques mandate entrance into the knee joint and require prolonged postoperative immobilization. The result may be excessive postoperative synovitis and occasionally, hemarthrosis. Prolonged postoperative immobilization results in joint stiffness. The authors propose a modification of Hauser's technique which allows tailored correction of the abnormal vector forces applied to the patella, simple adjustment of the tension in the extensor mechanism, creates patellar stability, and permits rapid return of knee motion. A new tibial corticocancellous window is created in a manner similar to Hauser's technique. The cancellous defect is deepened by curettage and the transferred tibial tubercle is then inverted, inserted through the window, and tamped into the graft bed thereby gradually increasing tension in the tendon. The cancellous and cortical bone from the window is then tamped in behind the patella tendon, buttressing the tendon, and permitting the knee a full unguarded range of motion on the operating table. In 23 operations in 22 patients, with a follow-up of 35.4 months and a mean patient age of 18.7 years, all patellae were stable. All but one patient achieved full range of motion. Younger patients with minimal or absent preoperative patellofemoral chondromalacia had uniformly good results.