title: The three-in-one proximal and distal soft tissue patellar realignment procedure. Results, and its place in the management of patellofemoral instability.
abstract: The three-in-one procedure for extensor mechanism realignment of the knee combines lateral release, vastus medialis obliquus muscle advancement, and transfer of the medial one-third of the patellar tendon to the tibial collateral ligament. We observed 37 patients (42 knees) receiving this treatment at a minimum 25-month follow-up (range, 25 to 85 months; mean, 44). Thirty-two of 42 knees (76%) with recurrent patellar dislocation had good or excellent results after surgery. Redislocation occurred in four knees (9.5%). Skeletal immaturity, chondral damage, and generalized ligament laxity did not seem to affect outcome. Thirty patients (37 knees) were studied 2 years earlier as well (mean follow-up, 29 months). When comparing the results 2 years later, there was a significant deterioration in outcome over time. These results are comparable with the published results for other techniques of patellar stabilization. We describe the place of the three-in-one operation in our surgical protocol for patellofemoral instability, which is based on the principle that a procedure should be selected to address the underlying pathologic features in an individual case rather than always using one operation for all cases.
authors.affiliation: Brisbane Orthopaedic and Sports Medicine Centre, Queensland, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Myers
authors.forename: A
authors.initials: A
authors.lastname: Williams
authors.forename: R
authors.initials: R
authors.lastname: Dodds
authors.forename: J
authors.initials: J
authors.lastname: Bülow
mesh_terms: D000293:Adolescent; D000328:Adult; D001182:Arthroscopy; D002358:Cartilage, Articular / Q000473:pathology; D017885:Collateral Ligaments / Q000473:pathology / Q000601:surgery; D005260:Female; D005269:Femur / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery; D007593:Joint Instability / Q000473:pathology / Q000601:surgery*; D007719:Knee Joint / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D010329:Patella / Q000473:pathology / Q000601:surgery*; D017847:Patellar Ligament / Q000637:transplantation; D012008:Recurrence; D016896:Treatment Outcome