Patella instability in children: surgical treatment results

Abstract

Introduction. Despite the fact that instability of the patella is a common pathology within the structure of knee joint diseases and injuries in children, currently there is no complete information on the basis of which one could judge the effectiveness and preference of a particular method of treating instability of the patella in children. Purpose of study: to evaluate the efficacy of surgical treatment techniques in children with post-traumatic instability of the patella. Patients and methods. The study was performed on the basis of examination and treatment data on 127 patients aged from 8 to 17 years with post-traumatic instability of the patella. Arthroscopic stabilization by Yamamoto technique, modified at our department, was performed in 49 patients, patella stabilization with transposition of the tibial tuberosity - in 67 patients, with the medial patellofemoral ligament autoplasty - 9, corrective osteotomy - in 2. Treatment efficacy was assessed using AKPS and 2000 IKDC knee joint assessment scores. The questionnaires were carried out at admission, in 1, 2-4 and 4-7 years after surgery. Results. At early terms after operation (up to 2 years) in the group of children after stabilization of the patella by modified Yamamoto technique good and excellent results were observed in 77.8% of cases, after transposition of the tibial tuberosity - in 73.3%, after stabilization of the patella with medial patellofemoral ligament autoplasty - in 88.9%. Long-term follow up (5-7 years) showed 90.9 and 86.5% of cases from the 1st and 2nd groups, respectively. Conclusion. The proposed algorithm for examination and treatment provides the most effective treatment and enables to obtain good and excellent results in the majority children with post-traumatic instability of the patella.