CONGENITAL DISLOCATION OF THE PATELLA – A MODIFIED SOFT TISSUE PROCEDURE

Abstract

We describe a successful modified operative procedure at an average 19 months follow-up in 3 patients with congenital dislocation of the patella and compare its merits to the other procedures already reported in the literature.

Congenital dislocation of the patella may be associated with other congenital conditions or syndromes i.e. Down’s syndrome, congenital vertical talus and cerebral palsy. Numerous operative techniques have been described in the literature which may be divided into 3 basic groups. A modification of the Langenskiold & Ritsila procedure is described. The original procedure describes an extensive lateral release with detachment and medial transfer of the patellar tendon through a curved incision. The tendon is routed through a fold of synovium medially and fixed distally to bone with sutures through drill holes in the proximal tibia. We found at surgery this synovium was too fragile to hold the transferred tendon and the use of drill holes unnecessary. The main alterations include a limited and straight anterior skin incision, a fashioning of a ‘buckle’ of the transferred distal patellar tendon to a distally based flap which avoids drill holes in the growing bone. This modification of the Langenskiold procedure was used successfully in 3 cases, including a revision of a failed Goldthwaite- Roux procedure in a mentally handicapped child. The results at average 19 months follow-up are successful. The early results confirm that the patella remains located and tracks normally. The valgus and flexion deformities have significantly improved.

This modification of the Langenskiold & Ritsila procedure requires less dissection than other operations, with no bony surgery and a cosmetic scar. The Langen-skiold & Ritsila procedure has been successful and we feel that this modification simplifies and improves on the original technique.