title: Surgical reconstruction of severe patellofemoral maltracking.
abstract: Dysfunction of the patellofemoral mechanism presents in many ways. Results from different realignment procedures show great variability in patient outcome. A surgical technique is presented that attempts to correct all the abnormalities of patellofemoral maltracking. The procedure consists of a lateral release, a vastus medialis (obliquus) tendon advancement, and a tibial tubercle transfer. Along with being moved medially, the tubercle also is moved distally to correct patella alta and elevated anteriorly to reduce patellofemoral joint reaction forces. One hundred seven knees in 84 patients were reviewed. Fifty-five percent of patients had frank dislocation. The remaining patients had anterior knee pain and had abnormal patella tracking on examination. The mean followup was 5.6 years. Seventy-nine percent of patients had a good to excellent functional outcome and 84% of patients stated they would have the operation again. Two patients with marked generalized ligamentous laxity had recurrent dislocation of the patella.
authors.affiliation: Australian Institute of Musculo-Skeletal Research, Sydney, Australia. simonandmichellepalmer@doctors.org.uk
authors.forename: Simon H
authors.initials: SH
authors.lastname: Palmer
authors.forename: Christopher T J
authors.initials: CT
authors.lastname: Servant
authors.forename: John
authors.initials: J
authors.lastname: Maguire
authors.forename: Simone
authors.initials: S
authors.lastname: Machan
authors.forename: Erin N
authors.initials: EN
authors.lastname: Parish
authors.forename: Mervyn J
authors.initials: MJ
authors.lastname: Cross
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000175:diagnosis / Q000601:surgery; D002648:Child; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017847:Patellar Ligament / Q000503:physiopathology / Q000601:surgery; D011182:Postoperative Care; D011336:Probability; D011859:Radiography; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods* / Q000534:rehabilitation; D020127:Recovery of Function; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome