Recurrent patellar dislocation: reappraising our approach to surgery.
BACKGROUND
The management of recurrent traumatic patellar dislocation includes surgical realignment. There is no clear distinction whether proximal soft tissue or distal procedures produce superior results. However, distal realignment procedures are commonly associated with greater morbidity. We advocate a distal procedure only for cases which are more severe, such as the presence of patellar maltracking.


METHODS
Between January 2002 and June 2007, all patients who had a history of traumatic patellar dislocation with recurrent symptoms and failed conservative management underwent surgical realignment. Patients who had evidence of lateral patellar subluxation on computed tomography (CT) scan were offered a distal realignment procedure using the Elmslie-Trillat or Roux Goldthwaite procedure. All other patients underwent proximal soft tissue medial patellofemoral ligament (MPFL) reconstruction. Pre and postoperative functional International Knee Documentation Committee (IKDC), Lysholm and Tegner score assessments were performed for a minimum follow-up period of 6 months. The mean scores for each group were analysed using the Wilcoxon Matched-Pairs Signed-Ranks test and the Mann-Whitney U test was used to evaluate the difference between the groups.


RESULTS
A total of 23 patients underwent surgery for patellar realignment. Of whom, 14 patients had a distal realignment procedure while 9 patients had a proximal procedure of MPFL reconstruction. There was greater morbidity reported with distal realignment procedures. Pre and postoperative IKDC, Lysholm and Tegner scores showed significant improvement for both treatment arms. However, there was no significant difference between the improvement scores for both groups.


CONCLUSIONS
Patients with significant patellar maltracking following traumatic patellar dislocation would benefit from distal realignment using the Elmslie-Trillat or Roux Goldthwaite procedure. Otherwise, a proximal soft tissue procedure involving MPFL reconstruction would be adequate. A management algorithm is proposed for clinical use.
Lim
Andrew K S
AK
Department of Orthopaedic Surgery, National University Hospital, Singapore. andrew.lim@nathealthgroup.com
Chang
Haw Chong
HC
Hui
James H P
JH
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D017760:Bone Malalignment / Q000601:surgery; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D008297:Male; D019637:Orthopedic Procedures; D031222:Patellar Dislocation / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D016896:Treatment Outcome