Abstract
Recurrent patellar dislocation is a relatively common disorder in young patients. Historically, treatment options have been based on the underlying disorder predisposing the patient to the dislocation. This has resulted in various soft tissue reefing procedures, patella tendon realignment procedures and boney realignment procedures.
Further research has shown that the medial patello-femoral ligament (MPFL) is the primary restraint to lateral patella subluxation and dislocation. Many authors have published their successful treatment of recurrent patella dislocation by reconstruction of the medial patellofemoral ligament. The most widely used is autologous semitendinosis tendon grafts, as well as synthetic materials, and MPFL reconstructions may be combined with boney procedures. Varieties of fixation techniques have been described involving both the patella and femoral sides.
We present a technique of MPFL reconstruction using the autologous ipsilateral quadriceps tendon. Our technique avoids the morbidity associated with semitendinosis graft harvesting and the drill holes in, and potential resulting fracture of, the patella. The technique is also simple and is associated with decreased procedure costs.
We present the technique and a series of six patients (seven knees) with follow up ranging from eight months to nine years. The average age of patients at the time of surgery 16 to 28 years (mean = 20 years). There have been no redislocations. The median Kujala patellofemoral knee score at follow up was 97 out of 100 (Range 69–100). The results compare very favorably to published results using other techniques.
Our technique of reconstructing the MPFL is reliable, produces good results using an objective knee score, and is cost effective.
Seventy staff members participated from a potential pool of approximately one hundred staff on duty at the time. Of the seventy staff who participated in this research project a total of three staff members were within 50 mls of the correct amount for each of the three samples. Overall staff were very poor at estimating blood loss.
Staff working in the operating theatre, no matter what their affiliation or years of experience, are not accurate when estimating blood loss spilt into a patients bed. A tool that aids in blood loss estimation is a valuable addition to the theatre resource manual.
Correspondence should be addressed to Associate Professor N. Susan Stott, Orthopaedic Department, Starship Children’s Hospital, Private Bag 92024, Auckland, New Zealand.
