title: Patella re-alignment in children with a modified Grammont technique.
abstract: OBJECTIVE
  In skeletally immature patients, surgical options due to recurrent patella dislocation are limited, because bony procedures bear the risk of growth disturbances. In this retrospective study, we report the long-term functional and radiographic outcome in skeletally immature patients using the modified Grammont surgical technique.
  
  
  METHODS
  Between 1999 and 2004, 65 skeletally immature knees (49 children) were treated with a modified Grammont procedure: an open lateral release and a shift of the patella tendon insertion below the growth plate on the tuberositas tibia, allowing the tendon to medialize. At mean 8 (5.6-11) years after surgery, 58 knees in 43 patients were evaluated by clinical examination, from functional scores (Lysholm, Tegner), and from radiographs of the knees.
  
  
  RESULTS
  Mean Lysholm score was 82 postoperatively. Tegner score decreased from 6.2 to 5. Eight knees had a single dislocation within 3 months of surgery. 3 knees had repeated late dislocations, all with a high grade of trochlea dysplasia. 6 knees showed mild signs of osteoarthritis. No growth disturbances were observed.
  
  
  CONCLUSIONS
  The modified Grammont technique in skeletally immature patients allows restoration of the distal patella tendon alignment by dynamic positioning. Long-term results showed that there were no growth disturbances and that there was good functional outcome. However, patients with a high grade of trochlea dysplasia tended to re-dislocate.
authors.affiliation: Department of Paediatric Orthopaedics, Medical University of Graz, Graz, Austria. tanjakraus@medunigraz.at
authors.forename: Tanja
authors.initials: T
authors.lastname: Kraus
authors.forename: Surjit
authors.initials: S
authors.lastname: Lidder
authors.forename: Martin
authors.initials: M
authors.lastname: Švehlík
authors.forename: Karoline
authors.initials: K
authors.lastname: Rippel
authors.forename: Frank
authors.initials: F
authors.lastname: Schneider
authors.forename: Robert
authors.initials: R
authors.lastname: Eberl
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Linhart
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D007717:Knee / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D031222:Patellar Dislocation / Q000601:surgery*; D017847:Patellar Ligament / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D013977:Tibia / Q000601:surgery