Abstract
To evaluate the clinical and functional results of surgical treatment of patellar dislocation in children. A prospective study was undertaken from January 1995 to December 2004. Patients who suffered from patellar dislocation after receiving intramuscular antibiotic injections to quadriceps were recruited. A complete history of each patient was recorded, and both a clinical and a roentgenographic examination were performed preoperatively. Patellar dislocation was classified according to Bensahel's criteria. The iliotibial tract and lateral retinacula was released to restore the tension of the medial retinaculum. Quadricepsplasty was used in all patients for full flexion of knee. There were nine males and 65 females in this study. All 74 patients (76 knees) developed dislocation of the patella after repeated intramuscular injections of antibiotic(s) into the quadriceps muscle. Fifty-six knees (73.7%) were type 1, and 20 knees (26.3%) were type 2 (Bensahel's classification). In all, we attained excellent results in 56 knees (73.7%), good results in 17 knees (22.4%), and fair results in three knees (3.9%). There have been no poor results or recurrences so far. Use of the iliotibial tract, adequate lateral retinacular release, restoration of the tension of the medial retinaculum and associated quadricepsplasty achieved a high success rate. The technique is simple, safe and effective in skeletally immature children.
Highlights
Dislocation of the patella is one of the most common problems seen in orthopedic practice and it has been well documented that dislocation causes chronic knee pain and instability in the pediatric and adolescent population
A The iliotibial tract is passed through the tunnel, B the iliotibial tract is passed through the tunnel
A The iliotibial tract is sutured to the patella and the free end is sutured to the semitendinosus muscle insertion, B the iliotibial tract is passed through the tunnel and sutured to the semitendinosus muscle insertion had bilateral problems
Summary
Dislocation of the patella is one of the most common problems seen in orthopedic practice and it has been well documented that dislocation causes chronic knee pain and instability in the pediatric and adolescent population. Baum and Bensahel [1] in 1973 and Bensahel et al [2] in 2000 presented deformities in dislocation of the patella and emphasized the concept of developmental dysplasia of the patella (DDP). There are many proposed mechanisms for this disorder, such as patellofemoral mechanism, dysplasia of distal femur, imbalance between lateral and medial retinacula (such as fibrous quadriceps caused by intramuscular antibiotic injection). A great number of surgical procedures have been described for realignment of the patellofemoral mechanism. Proximal realignment procedures alter the medial and lateral position of the patella by balancing the soft tissues proximal to its inferior pole. Since 1995, we have used the iliotibial tract to treat dislocation of patella in children. The reasons for using the iliotibia tract are simplicity and its effectiveness
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