Proximal Realignment of the Extensor Mechanism in Congenital Dislocation of the Knee in Children And Adolescents
DOI:
https://doi.org/10.1016/j.rccot.2020.09.005Keywords:
knee extensor mechanism, knee congenital dislocation, proximal realignmentAbstract
Background: Congenital dislocation of the patella (CDP) is a rare condition. The early diagnosis is difficult, as the patella in the newborns is small and also difficult to recognise. The therapeutic approach of this disorder requires the extended and external release of the quadriceps, the forward movement of the internal oblique vastus, and the transfer or hemi-transfer of the extensor compartment.
Methods: To review the functionality of those patients who have received surgical treatment with proximal realignment of the extensor mechanism using Green‘s surgical technique and the one modified by the author. Between the years 2000 and 2015, a total of 15 patients with 20 knees found to have had congenital dislocation of the patella, and had received the abovementioned surgical treatment.
Results: The post-operative results were evaluated using the Kujala questionnaire, which gave a mean result of 93.8 / 100.
Discussion: The CDP treatment is a challenge, and even more so if it is associated with an idiopathic retraction of the anterior rectus. The clinical and functional results obtained suggest that an anatomic and stable realignment of the patella in the femoral trochlea allows a satisfactory extensor alignment of the quadriceps. This leads to the disappearance its initial flexor action, which allows the gradual elongation of the extensor mechanism during the postoperative phases of rehabilitation. The surgical technique described offers a good alternative for the treatment of this rare congenital disorder of the knee.
Level of evidence: IV
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References
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