Abstract
ObjectiveTo evaluate the clinical and functional results of a surgical treatment of patellar dislocation whose etiology was iatrogenic quadriceps fibrosis in children.Materials and methodsA prospective study was undertaken from February 2004 to December 2009. The study included 54 pediatric patients (56 knees) that had developed dislocation of the patella after repeated intramuscular injections of antibiotic(s) into the quadriceps muscle. There were 11 males (20.4 %) and 43 females (79.6 %). The patients’ mean age at surgery was 7 years, 9 months (range 6 years, 4 months to 12 years, 6 months). A complete history of each patient was recorded. The affected knees were evaluated preoperatively and postoperatively on the basis of the symptoms, signs, and roentgenographic findings. Patellar dislocation was classified according Bensahel’s criteria. All patients had a three-part surgical procedure that combined capsulorrhaphy, quadricepsplasty, and transfer of the vastus medialis oblique to the superior border of the patella.ResultsThere has been no poor postsurgical result or recurrence so far; we have noted an ugly scar in nine knees (16.1 %), limitation of the knee flexion in five knees (8.9 %), and loss of extension of 5 °–20 ° in four knees (7.1 %). Overall, we attained excellent results in 39 knees (69.7 %), good results in 13 knees (23.2 %), and fair results in four knees (7.1 %).ConclusionIn our cases of pediatric dislocation of the patella caused by iatrogenic quadriceps fibrosis, the introduced three-part surgical procedure has shown great success in restoring the realignment mechanism of the patella. The technique is simple, safe, and effective in skeletally immature children.
Highlights
Patellar dislocation is common in children, and many operations have been described for its treatment [1,2,3]
In our cases of pediatric dislocation of the patella caused by iatrogenic quadriceps fibrosis, the introduced three-part surgical procedure has shown great success in restoring the realignment mechanism of the patella
Many factors contribute to patellar dislocation, including (1) congenital mechanisms and (2) a secondary mechanism, due to iatrogenic quadriceps fibrosis after intramuscular antibiotic(s) injections changed vector pull quadriceps, and fibrous vastus lateralis, vastus intermedius, and lateral retinacular patella; degeneration and contracture of the rectus femoris and vastus medialis
Summary
Patellar dislocation is common in children, and many operations have been described for its treatment [1,2,3]. Many factors contribute to patellar dislocation, including (1) congenital mechanisms (i.e., generalized ligamentous laxity, dysplasia of the patella or the femoral condyles, genu valgum, tight lateral bands, and patella alta [1,2,3]) and (2) a secondary mechanism, due to iatrogenic quadriceps fibrosis after intramuscular antibiotic(s) injections changed vector pull quadriceps, and fibrous vastus lateralis, vastus intermedius, and lateral retinacular patella; degeneration and contracture of the rectus femoris and vastus medialis. This second etiology, patellar dislocation secondary to intramuscular injections, was the subject of our study. All the conditions we associate with this contracture are well known, the importance of the underlying muscle condition in each case has not been stressed
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