Abstract
This paper reports the results of pes anserinus insertion as a dynamic transfer for habitual dislocation of the patella.
From 1995 to 2001 five patients were seen, ranging in age from 5 to 13 years. Follow-up ranged from nine months to three years. Through a long lateral incision, the iliotibial band and abnormal superolateral insertion of the vastus lateralis were divided. The lateral capsule down to the lateral border of the patellar tendon was released. Finally the vastus intermedius tendon was divided.
The rectus femoris was lengthened in one patient. Through a medial parapatellar incision, the pes anserinus insertion was detached with a sleeve of periosteum and sutured to the anteromedial aspect of the patella and patellar tendon to act as a dynamic check rein. The relaxed medial capsule was reefed before the transfer. The child was immobilised in an above-knee cast for four weeks after wound closure and later had physiotherapy.
In all patients the results were good. Movement was from 0° to 130° and there were no complications or redislocations. Skyline views showed the patella located in the groove.
Dynamic stabilisation of the patella in habitual dislocations yields more successful results. Preserving the vastus medialis helps prevent the extensor lag that usually occurs after these procedures. Abnormal insertion of the vastus lateralis and a tight iliotibial band were identified as the main causes of the dislocation. The failure of reconstructive procedures is perhaps due to the inadequate strength of the soft tissue used as a static medial stabiliser of the patella.
The abstracts were edited by Prof. M.B.E. Sweet. Correspondence should be addressed to him at the Department of Orthopaedic Surgery, Medical School, University of the Witwatersrand, 7 York Road, Parktown, 2193 South Africa
