THE VALUE OF SURGICAL RELEASE OF THE ILIOTIBIAL BAND IN TREATMENT OF IDIOPATHIC VALGUS DEFORMITY OF THE KNEE JOINT AND IN HABITUAL PATELLA SUBLUXATION AND LUXATION IN CHILDREN AND ADOLESCENT

Abstract

Introduction: When we have operate children’s knee in habitual luxation of the patella we noted, that iliotibial band have branch going to patella and to patella tendon.

It is important to the etiopathology of the patella luxation, but in valgus of the knee and in hyperpresion of the patella syndrome too.

Material and Method: In years 2000–2007 we have performed surgical iliotibial band release In 70 children, 28 boys and 42 girls.

In 19 children contracture of the iliotibial band were one-sided, in 51 children contracture were both-sided.

Patients were divided in to groups with various pre-operative symptoms:

• valgus of the knee – 40 patients (74 legs),

• valgus of the knee with subluxation of the patella in extension of the knee – 18 (31 legs),

• valgus of the knee with hyperpression of patella syndrome – 11 (15 legs),

• pathological knee valgity 1 (1 leg).

In all cases we performed surgically release of the iliotibial band. The incision was 5–10 cm over the joint space on the lateral side of the femur. The fasciotomy of the fascia lata and iliotibial band we make in “Z” shape. During operation we flex and extend the knee to be sure all fibres are released.

Findings: We have check late result (3 – 36 month postoperatively) in 45 patients (77 legs).

We estimate:

• 27 patients from group of valgus deformity of the knee

• 14 patients from group of valgus of the knee with subluxation of the patella

• 3 patients with group of valgus of the knee with hyperpression of patella syndrome

• 1 patient with pathological knee valgity

The valgus angle preoperatively reaches 12 to 35 (on average 16 for right leg and 16,5 for left). Postoperatively angle improve in all patients. Knee angle change from 5 to 20 degree (on average 8,4 for Wright leg, 8,3 for left).

In group with patella subluxation we have check 23 legs. In 11 patents (18 legs) the angle improve. The 3 patients (5 leg) later has full reconstruction of patello-femoral joint with patella tendon transposition. In patient with post inflammatory deformation the angle improve from 15 to 7 degree, but after next 34 month reaches again 20 degree and patient had osteotomy of the femur.

Conclusions:

1. iliotibial band release show us good result in correction the axis of the knee, first even during operation

2. After iliotibial band release is possible to move patella passive to medial side of the knee

3. Late result show us good effect in group of valgus of the knee deformity and in group with hyperpression of the patella syndrome

4. In group of subluxation of the patella effectivity of this method is 78%

5. We believe that surgical release of iliotibial band is easy and effective method of knee valgus correction in idiopathic valgity or in patella subluxation and in hyperpression of the patella syndrome.