TREATMENT OF ACUTE PATELLAR DISLOCATION WITH ARTHROSCOPIC MEDIAL RETINACULUM PLICATION IN ADOLESCENTS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAO Bo ¹ , RAN Xia ² , ZHANG Minghua ¹ , HE Chao ¹ , JIANG Dianming ³

1Department of Orthopedics, 2Department of Nephrology, Yongchuan Hospital, Chongqing Medical University, Yongchuan Chongqing, 402160, P.R.China;;
3Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University. Corresponding author: ZHANG Minghua, E-mail: zhangminghua023@126.com;

Corresponding author：

Keywords：

Acute patellar dislocation; Medial retinaculum plication; Arthroscopy; Adolescent

DOI：

10.7507/1002-1892.20130315

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Objective To investigate the effectiveness of arthroscopic medial retinaculum plication (MRP) for acute patellar dislocation (APD) in adolescents. Methods Between March 2007 and June 2011, 24 adolescent patients suffering from APD were treated by arthroscopic MRP. There were 14 males and 10 females, aged 8-18 years (mean, 12.7 years). The location was the left knee in 16 cases and the right knee in 8 cases. Injury was caused by sports in 19 cases, by traffic accident in 4 cases, and by heavy bruising in 1 case. The duration from injury to operation was 3 to 21 days with an average of 7.8 days. The results of floating patella test and dislocation apprehension test were both positive. MRI examination showed the arthroedema in all cases; associated injuries included medial retinaculum injury in 20 cases, medial patellar injury in 8 cases, and meniscus tear in 5 cases. Results All incisions healed by first intention without complication of infection or neurovascular injury. All the patients were followed up 12-36 months (mean, 14.6 months). Only 2 patients suffered from patellar re-dislocation at 4 months and 6 months after operation respectively. The knee joint activity returned to normal at 12 months. The Lysholm, Kujala, and International Knee Documentation Committee (IKDC) scores at 3 and 12 months after operation were significantly higher than those before operation (P lt; 0.05), and the scores at 12 months were significantly higher than those at 3 months (P lt; 0.05). Conclusion Treatment of APD with arthroscopic MRP has the advantages of minor trauma and good knee functional improvement. The technique can decrease incidence of patellar re-dislocation in adolescent.

Citation： ZHAO Bo,RAN Xia,ZHANG Minghua,HE Chao,JIANG Dianming. TREATMENT OF ACUTE PATELLAR DISLOCATION WITH ARTHROSCOPIC MEDIAL RETINACULUM PLICATION IN ADOLESCENTS. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(12): 1437-1441. doi: 10.7507/1002-1892.20130315 Copy

1.	陈坚, 倪磊, 吕厚山. 急性髌骨脱位的关节镜下诊断与治疗. 中华骨科杂志, 2006, 26(8): 505-508.
2.	Apostolovic M, Vukomanovic B, Slavkovic N, et al. Acute patellar dislocation in adolescents: operative versus nonoperative treatment. Int Orthop, 2011, 35(10): 1483-1487.
3.	Balcarek P, Jung K, Ammon J, et al. Anatomy of lateral patellar instability: trochlear dysplasia and tibial tubercle-trochlear groove distance is more pronounced in women who dislocate the patella. Am J Sports Med, 2010, 38(11): 2320-2327.
4.	Nietosvaara Y, Aalto K, Kallio PE. Acute patellar dislocation in children: incidence and associated osteochondral fractures. J Pediatr Orthop, 1994, 14(4): 513-515.
5.	Smith TO, Song F, Donell ST, et al. Operative versus non-operative management of patellar dislocation. A meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2011, 19(6): 988-998.
6.	Philippot R, Boyer B, Testa R, et al. The role of the medial ligamentous structures on patellar tracking during knee flexion. Knee Surg Sports Traumatol Arthrosc, 2012, 20(2): 331-336.
7.	Bedi H, Marzo J. The biomechanics of medial patellofemoral ligament repair followed by lateral retinacular release. Am J Sports Med, 2010, 38(7): 1462-1467.
8.	Hinton RY, Sharma KM. Acute and recurrent patellar instability in the young athlete. Orthop Clin North Am, 2003, 34(3): 385-396.
9.	Panagiotopoulos E, Strzelczyk P, Herrmann M, et al. Cadaveric study on static medial patellar stabilizers: the dynamizing role of the vastus medialis obliquus on medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc, 2006, 14(1): 7-12.
10.	Wang F, Kang HJ, Chen BC, et al. Combination of medial patellofemoral ligament reconstruction with vastus medialis advance-ment for chronic patellar dislocation. Chin Med J, 2010, 123(21): 3024-3029.
11.	Sillanpää P, Mattila VM, Iivonen T, et al. Incidence and risk factors of acute traumatic primary patellar dislocation. Med Sci Sports Exerc, 2008, 40(4): 606-611.
12.	Camanho GL, Viegas Ade C, Bitar AC, et al. Conservative versus surgical treatment for repair of the medial patellofemoral ligament in acute dislocations of the patella. Arthroscopy, 2009, 25(6): 620-625.
13.	Petri M, Liodakis E, Hofmeister M, et al. Operative vs conservative treatment of traumatic patellar dislocation: results of a prospective randomized controlled clinical trial. Arch Orthop Trauma Surg, 2013, 133(2): 209-213.
14.	Deie M, Ochi M, Sumen Y, et al. Reconstruction of the medial patellofemoral ligament for the treatment of habitual or recurrent dislocation of the patella in children. J Bone Joint Surg (Br), 2003, 85(6): 887-890.
15.	冯超, 王玉琨, 张建立, 等. 大收肌腱移位重建内侧髌股韧带治疗儿童复发性髌骨脱位初期效果分析. 中华小儿外科杂志, 2012, 33(6): 429-433.
16.	Zhao J, Huangfu X, He Y, et al. Recurrent patellar dislocation in adolescents: medial retinaculum plication versus vastus medialis plasty. Am J Sports Med, 2012, 40(1): 123-132.
17.	Ji G, Wang F, Zhang Y, et al. Medial patella retinaculum plasty for treatment of habitual patellar dislocation in adolescents. Int Orthop, 2012, 36(9): 1819-1825.
18.	Nomura E. Classification of lesions of the medial patello-femoral ligament in patellar dislocation. Int Orthop, 1999, 23(5): 260-263.
19.	Sanders TG, Morrison WB, Singleton BA, et al. Medial patellofemoral ligament injury following acute transient dislocation of the patella: MR findings with surgical correlation in 14 patients. J Comput Assist Tomogr, 2001, 25(6): 957-962.
20.	White BJ, Sherman OH. Patellofemoral instability. Bull NYU Hosp Jt Dis, 2009, 67(1): 22-29.
21.	Tom A, Fulkerson JP. Restoration of native medial patellofemoral ligament support after patella dislocation. Sports Med Arthrosc, 2007, 15(2): 68-71.
22.	Fithian DC, Paxton EW, Cohen AB. Indications in the treatment of patellar instability. J Knee Surg, 2004, 17(1): 47-56.
23.	徐才祺, 赵金忠. 关节镜下髌骨内侧支持带紧缩术治疗青少年复发性髌骨脱位. 中国修复重建外科杂志, 2011, 25(8): 931-936.

1. 陈坚, 倪磊, 吕厚山. 急性髌骨脱位的关节镜下诊断与治疗. 中华骨科杂志, 2006, 26(8): 505-508.
2. Apostolovic M, Vukomanovic B, Slavkovic N, et al. Acute patellar dislocation in adolescents: operative versus nonoperative treatment. Int Orthop, 2011, 35(10): 1483-1487.
3. Balcarek P, Jung K, Ammon J, et al. Anatomy of lateral patellar instability: trochlear dysplasia and tibial tubercle-trochlear groove distance is more pronounced in women who dislocate the patella. Am J Sports Med, 2010, 38(11): 2320-2327.
4. Nietosvaara Y, Aalto K, Kallio PE. Acute patellar dislocation in children: incidence and associated osteochondral fractures. J Pediatr Orthop, 1994, 14(4): 513-515.
5. Smith TO, Song F, Donell ST, et al. Operative versus non-operative management of patellar dislocation. A meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2011, 19(6): 988-998.
6. Philippot R, Boyer B, Testa R, et al. The role of the medial ligamentous structures on patellar tracking during knee flexion. Knee Surg Sports Traumatol Arthrosc, 2012, 20(2): 331-336.
7. Bedi H, Marzo J. The biomechanics of medial patellofemoral ligament repair followed by lateral retinacular release. Am J Sports Med, 2010, 38(7): 1462-1467.
8. Hinton RY, Sharma KM. Acute and recurrent patellar instability in the young athlete. Orthop Clin North Am, 2003, 34(3): 385-396.
9. Panagiotopoulos E, Strzelczyk P, Herrmann M, et al. Cadaveric study on static medial patellar stabilizers: the dynamizing role of the vastus medialis obliquus on medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc, 2006, 14(1): 7-12.
10. Wang F, Kang HJ, Chen BC, et al. Combination of medial patellofemoral ligament reconstruction with vastus medialis advance-ment for chronic patellar dislocation. Chin Med J, 2010, 123(21): 3024-3029.
11. Sillanpää P, Mattila VM, Iivonen T, et al. Incidence and risk factors of acute traumatic primary patellar dislocation. Med Sci Sports Exerc, 2008, 40(4): 606-611.
12. Camanho GL, Viegas Ade C, Bitar AC, et al. Conservative versus surgical treatment for repair of the medial patellofemoral ligament in acute dislocations of the patella. Arthroscopy, 2009, 25(6): 620-625.
13. Petri M, Liodakis E, Hofmeister M, et al. Operative vs conservative treatment of traumatic patellar dislocation: results of a prospective randomized controlled clinical trial. Arch Orthop Trauma Surg, 2013, 133(2): 209-213.
14. Deie M, Ochi M, Sumen Y, et al. Reconstruction of the medial patellofemoral ligament for the treatment of habitual or recurrent dislocation of the patella in children. J Bone Joint Surg (Br), 2003, 85(6): 887-890.
15. 冯超, 王玉琨, 张建立, 等. 大收肌腱移位重建内侧髌股韧带治疗儿童复发性髌骨脱位初期效果分析. 中华小儿外科杂志, 2012, 33(6): 429-433.
16. Zhao J, Huangfu X, He Y, et al. Recurrent patellar dislocation in adolescents: medial retinaculum plication versus vastus medialis plasty. Am J Sports Med, 2012, 40(1): 123-132.
17. Ji G, Wang F, Zhang Y, et al. Medial patella retinaculum plasty for treatment of habitual patellar dislocation in adolescents. Int Orthop, 2012, 36(9): 1819-1825.
18. Nomura E. Classification of lesions of the medial patello-femoral ligament in patellar dislocation. Int Orthop, 1999, 23(5): 260-263.
19. Sanders TG, Morrison WB, Singleton BA, et al. Medial patellofemoral ligament injury following acute transient dislocation of the patella: MR findings with surgical correlation in 14 patients. J Comput Assist Tomogr, 2001, 25(6): 957-962.
20. White BJ, Sherman OH. Patellofemoral instability. Bull NYU Hosp Jt Dis, 2009, 67(1): 22-29.
21. Tom A, Fulkerson JP. Restoration of native medial patellofemoral ligament support after patella dislocation. Sports Med Arthrosc, 2007, 15(2): 68-71.
22. Fithian DC, Paxton EW, Cohen AB. Indications in the treatment of patellar instability. J Knee Surg, 2004, 17(1): 47-56.
23. 徐才祺, 赵金忠. 关节镜下髌骨内侧支持带紧缩术治疗青少年复发性髌骨脱位. 中国修复重建外科杂志, 2011, 25(8): 931-936.

Chinese Journal of Reparative and Reconstructive Surgery

TREATMENT OF ACUTE PATELLAR DISLOCATION WITH ARTHROSCOPIC MEDIAL RETINACULUM PLICATION IN ADOLESCENTS

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