Trillat Procedure Research Articles

Elmslie–Trillat Procedure for the Treatment of Recurrent Patellar Instability

Elmslie–Trillat Procedure for the Treatment of Recurrent Patellar Instability

Elmslie–Trillat Procedure for the Treatment of Recurrent Patellar Instability

The purpose of this study was to evaluate the mid-term results of the Elmslie-Trillat procedure for the treatment of patella instability. Patella instability can be addressed by proximal, distal, and combined approaches. The Elmslie-Trillat procedure is a combined bony distal realignment with medial soft tissue technique offering a more rapid recovery than more extensive distal realignments. A consecutive series of patients with recurrent patellar instability treated with a modified Elmslie-Trillat procedure were assessed subjectively by visual analog scale, Tegner scale, and both pre-and postoperatively by physical examination, International Knee Documentation Committee activity, Lysholm, and Fulkerson knee scores. Inclusion criteria were patients with recurrent lateral dislocations or increasingly frequent subluxations who failed nonoperative therapy. Exclusion criteria were open growth plates, patellofemoral arthritis, and concurrent cruciate ligament or meniscal injuries. The primary endpoint was evidence of recurrent instability. The secondary endpoint was the functional scoring status. Thirty-five knees were evaluated for an average of 98 months (range, 25 to 209) postsurgery. The average age was 27.7 years. Twelve had failed a previous surgery to correct the patellar instability. The mean Lysholm and Fulkerson scores improved from 44.5 and 42.4 to 83.4 and 84.3, respectively. Follow-up Tegner score was 3.8, and the average visual analog scale score was 7.9 out of 10. Two patients had recurrent dislocations and 1 had a single subluxation 6 weeks after surgery. The Elmslie-Trillat procedure successfully eliminated recurrent patellar instability in 91.4%. Functionally, all patients were improved at an average of 98 months after surgery. Level IV, therapeutic case series.

Functional outcome following modified Elmslie–Trillat procedure

The aim of this study was to evaluate the mid- and long-term outcome of the modified Elmslie–Trillat procedure, as well as to detect factors affecting it. Thirty-eight patients (44 procedures) with a mean age of 31 years were included in this study. The reason for operation was patellar instability in 10 cases, anterior knee pain with malalignment of the extensor mechanism in 15 cases and a combination of both in 19 cases. Patients were followed for an average of 40 months (range = 18–130 months). The functional outcome was very satisfactory or satisfactory for 73% of patients. According to Cox's criteria it was excellent in 13 cases (30%), good in 18 (41%), fair in 7 (16%) and poor in the remaining 6 (13%). Patients scored an average of 3.5 (range = 2–8) in their Tegner Activity Scale, while their score in Activities of Daily Living Scale of the Knee Outcome Survey ranged from 43 to 98 (average = 76). Result analysis revealed a better functional outcome when the operation was performed for patellar instability, as well as in the absence of grade 3 or 4 chondral changes in the patellofemoral joint at the time of operation. Elmslie–Trillat procedure satisfactorily restores patellofemoral stability and offers a very good functional outcome, especially in the absence of significant chondral changes in the patellofemoral joint at the time of operation.

Functional evaluation of the modified Elmslie–Trillat procedure for patello-femoral dysfunction

A series of 28 knees in 27 patients were evaluated at an average of 36 months following surgical treatment for patella dislocation, patello-femoral pain, or a combination of both. All cases were treated by the modified Elmslie–Trillat procedure, which involves a lateral retinacular release and medialisation of the tibial tubercle on a distal pedicle. The evaluation included subjective, objective (Fulkerson and Kujala functional knee scores) and radiographic assessments. Subjectively, eight knees (28%) had excellent results, nine knees (33%) good results and seven knees (25%) fair results, accounting for an overall improvement of 86% over the preoperative status. All the knees in patients with a primary symptom of patella dislocation had an excellent or good subjective result, whilst only four knees (40%) in those patients with a primary symptom of pain and four knees (44%) in those with both pain and dislocation had a good or excellent result. The mean objective knee score was excellent for patients with dislocation only, and fair for those with only pain or both pain and dislocation. There have been no further episodes of dislocation in all patients. Six knees (21%) required later screw removal. The modified Elmslie–Trillat procedure produces a favourable outcome in patients with patella dislocation.

Old Unreduced Posterior Sternoclavicular Dislocation and Coracoid Impingement

Old Unreduced Posterior Sternoclavicular Dislocation and Coracoid Impingement

The Elmslie–Trillat Procedure

The Elmslie–Trillat Procedure

Management of recurrent dislocation of the patella following total knee arthroplasty

Fifteen knees with patellar dislocation after total knee arthroplasty had realignment of the extensor mechanism using a modification of the Trillat procedure. The onset of dislocation occurred on average 4.7 months from the time of surgery. After total knee arthroplasty the patients had an average range of motion of 109°. All patients had medialization of the tibial tubercle and lateral release. No patient had a recurrent dislocation after a minimum 2-year follow-up period. The average knee score was 82 and the average flexion arc was 112°. All but one of the osteotomies healed uneventfully.

The Trillat procedure for recurrent anterior instability of the shoulder.

In the Trillat procedure for recurrent anterior instability of the shoulder the coracoid process is osteotomised and tilted downward to act as a bone block, and a screw is used to fix it and the Bankart lesion to the anterior scapular neck. We reviewed 52 cases after a mean follow-up of 69 months. Results in 73% of shoulders were excellent, 10% were good, 7% fair and 10% poor. Dislocation recurred in 4%, but a positive apprehension sign was present in 10 other shoulders. Some degenerative changes were seen in 62% of shoulders, a complication known to be associated with bone-block procedures. The most important reason for loss of lateral rotation was iatrogenic impingement of the coracoid. This frequent and potentially serious complication can also cause posterior subluxation of the humeral head and osteoarthritis.

An evaluation of the Elmslie-Trillat procedure for management of patellar dislocations and subluxations: a preliminary report.

The Elmslie-Trillat procedure involves lateral retinacular release, medial capsular reefing, and medial transposition of the anterior tibial tubercle hinged on a distal periosteal attachment. It is an easily performed procedure and is an excellent method for realignment of the extensor mechanism in cases of dislocation and subluxation of the patella. In our series of 52 cases with 6-24 months postsurgical evaluation, 46 cases, or 88 percent were rated as good or excellent. It must be emphasized that this technique is used only if the epiphyseal plates are closed.