surgical treatment of congenital and obligatory ...€¦ · dislocation of the patella in children...

SURGICAL TREATMENT OF CONGENITAL AND OBLIGATORY DISLOCATION OF THE PATELLA IN CHILDREN Ronen Sever, MD 1 Michael Fishkin, MD 1 Shlomo Wientroub, MD 1, ,Moshe Yaniv, MD 1 1 Department of Pediatric Orthopaedics, Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel INTRODUCTION Dislocation of the patella in children is a complex problem which may pose a surgical challenge. Congenital (fixed) dislocation and obligatory (habitual) dislocations, represent the most severe cases. We present a retrospective case series, summarizing our results with a surgical technique, based on the principles originally described by Stanisavljevic, for the correction of congenital permanent irreducible patellar dislocation METHODS The procedure includes extensive subperiosteal quadriceps realignment and soft tissue medial plication, followed by distal realignment through patellar tendon splitting. The outcome measures were patellar stability, knee ROM, Pedi-IKDC knee function score and the PODCI global function score. The study group included 12 patients, 9 females and 3 males (15 knees) whose mean age was 7 years 5 months at surgery. Nine patients had an underlying diagnosed genetic background (Down syndrome [n = 6], Larsen syndrome [n = 2], Nail-patella syndrome [n = 1]). Mean follow-up was 46.2 months. RESULTS Eleven patients, gained stable patella with no recurrence of dislocation. Postoperative knee active extension was improved significantly (p < 0.0001) for all patients. The average postoperative Pedi-IKDC and PODCI scores were significantly higher (p < 0.001) among the idiopathic group. DISCUSSION Congenital and obligatory patellar dislocations represent a complex challenge. Numerous treatment options and results are reported in the literature, offering different perspectives and surgical solutions. Analysis of our results with the literature reported cases suggests that early realignment of the extensor mechanism is critical, in order to avoid secondary growth changes and thus, prevent recurrences. CONCLUSIONS We advocate the implementation of the Stanisavljevic' procedure principles in young age as safe and reproducible solution to the complicated condition of fixed and obligatory patellar dislocation in children. Contact Information: M. Yaniv MD , Department of Pediatric Orthopaedics, Tel Aviv Medical Center, E-mail: [email protected]

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SURGICAL TREATMENT OF CONGENITAL AND OBLIGATORY DISLOCATION OF THE PATELLA IN CHILDREN

Ronen Sever, MD1 Michael Fishkin, MD1 Shlomo Wientroub, MD1, ,Moshe Yaniv, MD11 Department of Pediatric Orthopaedics, Tel Aviv Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

INTRODUCTION

Dislocation of the patella in children is a complex problem which may pose a surgical challenge. Congenital (fixed) dislocation and obligatory (habitual) dislocations, represent the most severe cases. We present a retrospective case series, summarizing our results with a surgical technique, based on the principles originally described by Stanisavljevic, for the correction of congenital permanent irreducible patellar dislocation

METHODSThe procedure includes extensive subperiosteal quadriceps realignment and soft tissue medial plication, followed by distal realignment through patellar tendon splitting. The outcome measures were patellar stability, knee ROM, Pedi-IKDC knee function score and the PODCI global function score. The study group included 12 patients, 9 females and 3 males (15 knees) whose mean age was 7 years 5 months at surgery. Nine patients had an underlying diagnosed genetic background (Down syndrome [n = 6], Larsen syndrome [n = 2], Nail-patella syndrome [n = 1]). Mean follow-up was 46.2 months.

RESULTSEleven patients, gained stable patella with no recurrence of dislocation. Postoperative knee active extension was improved significantly (p < 0.0001) for all patients. The average postoperative Pedi-IKDC and PODCI scores were significantly higher (p < 0.001) among the idiopathic group.

DISCUSSION

Congenital and obligatory patellar dislocations represent a complex challenge. Numerous treatment options and results are reported in the literature, offering different perspectives and surgical solutions. Analysis of our results with the literature reported cases suggests that early realignment of the extensor mechanism is critical, in order to avoid secondary growth changes and thus, prevent recurrences.

CONCLUSIONSWe advocate the implementation of the Stanisavljevic' procedure principles in young age as safe and reproducible solution to the complicated condition of fixed and obligatory patellar dislocation in children.

Contact Information: M. Yaniv MD , Department of Pediatric Orthopaedics, Tel Aviv Medical Center, E-mail: [email protected]

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