J Korean Orthop Assoc.  2007 Feb;42(1):1-7. 10.4055/jkoa.2007.42.1.1.

The "Four-in-One" Procedure for Habitual Patellar Dislocation in Children with Formation Failure of Femoral Trochlea and Generalized Ligamentous Laxity : A Preliminary Report

• Joo SY
• Park KB
• Kim BR
• Park HW
• Kim HW

• KMID: 2106368
• DOI: http://doi.org/10.4055/jkoa.2007.42.1.1

Abstract

Purpose: To evaluate the clinical results of a "Four-in-One" procedure for a habitual dislocation of the patella in children with generalized ligamentous laxity and formation failure of the femoral trochlea.
Materials and Methods
Five knees in 4 patients were included in this study. The average age of the patients at the time of surgery was 5.9 years and the subjects were followed up for an average of 41.6 months postoperatively. The clinical results were evaluated using the criteria of the Kujala's scoring system as well as a physical examination and radiological findings.
Results
During the follow-up period, there were no recurrent dislocations, knee joint pain, limitations of motion or gait disturbances in any of the cases. The mean Kujala score was 96.8. Two cases had complications related to wound healing but they healed eventually.
Conclusion
The "Four-in-One" procedure, which include the lateral retinacular release, medial vector augmentation, semitendinosus tenodesis, and patellar tendon transfer is recommended for a habitual dislocation of the patella in children with generalized ligament laxity and formation failure of the femoral trochlea.

Keyword

Patella; Habitual dislocation; Children; Four-in-one procedure

MeSH Terms

Arthralgia
Child*
Dislocations
Follow-Up Studies
Gait
Humans
Knee
Knee Dislocation
Ligaments*
Patella
Patellar Dislocation*
Patellar Ligament
Physical Examination
Tenodesis
Wound Healing

Figure

• 

  Fig. 1 A Four-year-old girl with a habitual dislocation of the patella. Preoperative Merchant view shows a dislocation of the left patella with severe trochlear hypoplasia.

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  Fig. 2 Semitendinosus tenodesis and patellar tendon transfer. Semitendinosus tendon was cut at the level of the musculotendinous junction, and was sutured to the patella using a suture anchor. The lateral half of the patellar tendon was split, directed under the medial half of the tendon and attached to the periosteum of the tibia.

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  Fig. 3 Proximal realignment procedure. The vastus medialis was transferred distally and medially.

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  Fig. 4 Merchant view taken 8 months after surgery shows a well-located patella in the trochlea groove.

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  Fig. 5 Merchant view taken 4 years after surgery shows a developed trochlear groove and a well-reduced patella.

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