16-Sep-96 1:00 PM CST

Surgical Correction of Medial Subluxation of the Patella

The American Journal of Sports Medicine, Vol. 24, No. 4

Author: Jack C. Hughston, MD, Fred Flandry, MD, Mark r. Brinker, MD, Glenn C. Terry, MD, and James C. Mills III, MD

Click here to read the entire published article by Dr Brinker

Medial subluxation of the patella is a disabling condition that most commonly arises as the result of a lateral retinacular release procedure. The diagnostic criteria include the ability to passively subluxate or dislocate the patella medially, with the re-creation of painful symptom. that are familiar to the patient. This clinical entity was initially described in 1988.

Patients with iatrogenic medial subluxation are often severely limited in their activities, are unable to work, and experience giving way with subluxation and unremitting pain. Our patients often had had multiple operations that failed to correct their painful symptoms. They often were under professional care for clinical depression or anxiety disorders related to their disabilities.

Failure of our initial physical therapy and rehabilitation required surgical correction, which we did by exposure of the extensor mechanism of the knee with direct repair or reconstruction of the lateral stabilizers of the patella in these patients.

We present a surgical technique for correction of medial patellar subluxation and review its results.

MATERIALS AND METHODS

From June 1984 to October 1990, 70 surgical procedures were performed on 68 consecutive patients who had medial subluxation of the patella. Data for this study were obtained by followup visits, telephone conversations, and a review of the medical records. We were able to do follow- up evaluation on 65 knees in 63 patients who had at least a 2-year interval from surgery to followup evaluation. The average age of all patients at the time of surgery was 29.2 years (range, 14 to 49). Surgery was performed on 50 women and 13 men, and there were 31 left knees and 34 right knees. The average follow-up period was 53.7 months (range, 24 to 99).

All 63 patients (65 knees) had a history of one or more previous operations. Nineteen knees (29%) had only 1 previous operation. 14 (22%) had 2, 11 (17%) had 3, 8 (12%) had 4, and 13 (20%) had 5 or more previous operations .

Overall, 58 of the 65 knees (89%) had previously undergone a lateral retinacular release, with an arthroscopic lateral release being the most common procedure. The remaining seven cases of subluxation were due to other surgical or traumatic causes. Of the 58 knees that had had...

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