SURGICAL TREATMENT OF PERSISTENT AND RECURRENT PATELLAR DISLOCATIONS
https://doi.org/10.57256/2949-0715-2025-4-2-71-78
Abstract
Background. Damage and biomechanical disorders of the patella-femoral articulation significantly worsen the general functional state of the knee joint.
Aim. To evaluate the effectiveness of known methods of surgical treatment of persistent and recurrent patellar dislocations and to clarify the indications for their use depending on the type of chronic instability.
Materials and methods. Surgical treatment was performed on 24 patients with patellar instability, which were divided into 4 groups according to the Blumensaat classification: 1. persistent habitual subluxations 2. persistent habitual dislocations 3. recurrent post-traumatic dislocations 4. persistent permanent dislocations.
Clinical, radiological, magnetic resonance and arthroscopic methods were used.
Results. In 10 patients with persistent habitual subluxations of the patella, a percutaneous suture of the medial retinaculum according to Yamamoto and release of the lateral retinaculum were performed.
In 8 patients with persistent habitual dislocations of the patella, a release of the lateral retinaculum and an anchor suture of the patellafemoral ligament to the inner edge of the patella were performed, using two titanium Fastin fixators.
In 4 patients with relapses after surgical treatment of habitual dislocations of the patella (suturing of the medial retinaculum according to Yamamoto), autoplasty of the medial patellafemoral ligament with the tendon of the semitendinosus muscle according to Schottle-Weiler in our modification was performed. In 2 patients with permanent persistent dislocation of the patella, the release of the lateral retinaculum with mobilization of the tendon of the straight head of the quadriceps and transposition of the tibia tuberosity with the patellar ligament (medialization and reduction) were performed.
When studying the remote results in periods from 6 to 7 years, all patients had no recurrence of dislocations and subluxations of the patella. The full range of motion in the knee joint was preserved.
Conclusion. The conducted study demonstrated that an individualized selection of surgical strategy, based on the Blumensaat classification and time elapsed since injury, combined with modified minimally invasive techniques, ensures reliable patellar stabilization and sustained functional outcomes in the long-term period.
About the Authors
Igor E. KomogortsevRussian Federation
Dr. Sci. (Med.), Professor, Head of the Department of Traumatology and orthopedics
Alexey Iu. Krasovsky
Russian Federation
traumatologist-orthopedist, head of department
Ivan V. Kalashnikov
Russian Federation
traumatologist-orthopedist
Adrey A. Ilin
Russian Federation
Head of the Department of Traumatology and Orthopedics № 2, traumatologist-orthopedist
Anatoliy G. Urbanov
Russian Federation
traumatologist-orthopedist
Alexander B. Namoguruev
Russian Federation
traumatologist-orthopedist
Alexey A. Melkostupov
Russian Federation
Assistant Professor, Department of Traumatology and Orthopedics
Ekaterina G. Angarskaya
Russian Federation
Assistant Professor, Department of Traumatology and Orthopedics
Evgeniya G. Komogortseva
Russian Federation
Dr. Sci. (Med.), Professor of the Department of Hospital Therapy
References
1. Kayll S.A., Hinman R.S., Bennell K.L. et al. Do biomechanical foot-based interventions reduce patellofemoral joint loads in adults with and without patellofemoral pain or osteoarthritis? A systematic review and meta-analysis. Br J Sports Med. 2023;57(7):404–412. https://doi.org/10.1136/bjsports-2022-106348.
2. Souza Júnior J.R., Gaudette L.W., Johnson C.D. et al. Interaction of biomechanical, anthropometric, and demographic factors associated with patellofemoral pain in rearfoot strike runners: a classification and regression tree approach. Sports Med Open. 2024;10(1):5. https://doi.org/10.1186/s40798-023-00671-8.
3. Wang Y., Zhang Y., Li J. et al. Simultaneous Measurement of Patellofemoral Joint Kinematics and Contact Mechanics in Intact Knees: A Cadaveric Study. Front Bioeng Biotechnol. 2022;10:9483075. https://doi.org/10.3389/fbioe.2022.9483075.
4. Guan S., Gray H.A., Thomeer L.T., Pandy M.G. A Two-Degree-of-Freedom Knee Model Predicts Full Three-Dimensional Tibiofemoral and Patellofemoral Joint Motion During Functional Activity. Ann Biomed Eng. 2023;51(3):493–505. https://doi.org/10.1007/s10439-022-03048-2.
5. Patel D.V., Dávila Castrodad I.M., Kurowicki J. et al. Patellofemoral Instability. In: Suárez-Ahedo C, editor. Arthroscopy. London: IntechOpen; 2021. https://doi.org/10.5772/intechopen.99562.
6. Barbosa R.M., da Silva M.V., Macedo C.S. et al. Imaging evaluation of patellofemoral joint instability: a review. Knee Surg Relat Res. 2023;35(1):7. https://doi.org/10.1186/s43019-023-00180-8.
7. Morello V., Zingg M., Tscholl P. The prevalence of radiographic trochlear dysplasia in patients with patellar fractures. BMC Musculoskelet Disord. 2024;25(1):1091. https://doi.org/10.1186/s12891-024-08204-4.
8. Post W.R., Fithian D.C., Willimon S.C. et al. Patellofemoral Instability: A Consensus Statement From the AOSSM/PFF Patellofemoral Instability Workshop. Orthop J Sports Med. 2018;6(1):2325967117750352. https://doi.org/10.1177/2325967117750352.
9. Migliorini F., Maffulli N., Vaishya R. Patellofemoral instability: Current status and future perspectives. J Orthop. 2022;36:49–50. https://doi.org/10.1016/j.jor.2022.12.010.
10. Guan S., Gray H.A., Thomeer L.T., Pandy M.G. A Two-Degree-of-Freedom Knee Model Predicts Full Three-Dimensional Tibiofemoral and Patellofemoral Joint Motion During Functional Activity. Ann Biomed Eng. 2023;51(3):493–505. https://doi.org/10.1007/s10439-022-03048-2.
11. Migliorini F., Marsilio E., Oliva F. et al. Chondral injuries in patients with recurrent patellar dislocation: a systematic review. J Orthop Surg Res. 2022;17(1):63. https://doi.org/10.1186/s13018-022-02911-1.
12. Holliday C.L., Hiemstra L.A., Kerslake S., Grant J.A. Relationship between anatomical risk factors, articular cartilage lesions, and patient outcomes following medial patellofemoral ligament reconstruction. Sports Health. 2021;13(1):39–45. https://doi.org/10.1177/1941738120968472.
13. Kamat Y., Prabhakar A., Shetty V., Naik A. Patellofemoral joint degeneration: A review of current management. J Clin Orthop Trauma. 2021;24:101690. https://doi.org/10.1016/j.jcot.2021.101690.
14. Nha K.W., Kim H.S., Cho S.T. et al. Arthroscopy-controlled medial reefing and lateral release for recurrent patellar dislocation: clinical, radiologic outcomes and complications. BMC Musculoskelet Disord. 2021;22(1):430. https://doi.org/10.1186/s12891-021-04300-x.
15. Pohlig F., Lenze U., Lenze F.W. et al. Arthroscopic lateral retinacular release improves patello-femoral and femoro-tibial kinematics in patients with isolated lateral retinacular tightness. Knee Surg Sports Traumatol Arthrosc. 2022;30(3):791–799. https://doi.org/10.1007/s00167-021-06434-w.
16. Başal Ö., Dinçer R. Arthroscopic medial patellofemoral ligament reconstruction with a double suspension technique. Eur Arch Med Res. 2023;39(1):64–69. https://doi.org/10.4274/eamr.galenos.2022.60565.
17. Zhou K., Bai P., Sun Z. et al. Distalization of tibial tubercle osteotomy is not necessary for patients with recurrent patellar dislocation accompanied by patella alta and increased TT–TG distance. BMC Musculoskelet Disord. 2022;23(1):838. https://doi.org/10.1186/s12891-022-05779-8.
18. Xu T., Zhu Y., Zhang L., Xie H.Q., Fu W. Results of Medial Patellofemoral Ligament Reconstruction with and without Tibial Tubercle Transfer in Patellar Instability: A Systematic Review and Meta-Analysis. Orthop Surg. 2023;15(11):2766–2776. https://doi.org/10.1111/os.13870.
19. McNamara N.E., Shing E.Z., Khalil A.Z. et al. Evaluating the Impact of Tibial Tubercle Osteotomy in Adult Patients on Patellar Height and Patellar Tendon Length. Orthop J Sports Med. 2025;13(2):23259671251327418. https://doi.org/10.1177/23259671251327418.
20. Samelis P. Patellar Dislocation: Workup and Decision-Making. Cureus. 2023;15(10):e10631568. https://doi.org/10.7759/cureus.10631568.
21. Tan S.H.S., Ngiam E.H.K., Lim J.Y., Lim A.K.S., Hui J.H.P. Surgical Management of Patella Alta in Patellofemoral Instability: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2021;9(4):2325967121999642. https://doi.org/10.1177/2325967121999642.
22. Balcarek P., Oberthur S., Frosch K.H. Pathoanatomy and pathomechanics in recurrent patellar dislocation: diagnostic workup and surgical treatment. Knee Surg Sports Traumatol Arthrosc. 2021;29(2):387–394. https://doi.org/10.1007/s00167-020-06010-6.
23. Lee D.H., Park Y.S., Kim J. et al. Morphological risk factors for recurrent patellar dislocation: a systematic review and meta-analysis. Knee Surg Relat Res. 2022;34(1):12. https://doi.org/10.1186/s43019-022-00119-x.
24. Smith T.O., Davies L., Toms A.P., Donell S.T. The influence of femoral trochlear dysplasia on patellar stability: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2023;31(4):1161–1170. https://doi.org/10.1007/s00167-022-06903-5.
25. Zhao C., Deng Y., Sun C. et al. Effect of genu valgum deformity on patellar stability and outcomes of surgical treatment for patellar dislocation. J Orthop Surg Res. 2021;16(1):516. https://doi.org/10.1186/s13018-021-02692-1.
26. Kang H.J., Lee Y.S., Lee J.H. et al. Outcomes of arthroscopic lateral retinacular release in patients with mild to moderate patellar subluxation. Arthroscopy. 2022;38(1):150–157. https://doi.org/10.1016/j.arthro.2021.07.012.
27. Ouyang P., Tan Q., He X., Zhao B. Computational comparison of anterior lumbar interbody fusion and oblique lumbar interbody fusion with various supplementary fixation systems: a finite element analysis. J Orthop Surg Res. 2023;18(1):4. https://doi.org/10.1186/s13018-022-03480-z.
28. Goyal D., Kaushik S., Maheshwari R. Role of medial retinacular repair combined with lateral retinacular release in recurrent patellar instability: a systematic review. J Orthop Surg Res. 2022;17(1):227. https://doi.org/10.1186/s13018-022-03166-z.
29. Kim S.J., Lee J.H., Park S.H. et al. Outcomes of isolated lateral retinacular release versus combined medial repair for patellar instability: a prospective comparative study. Knee Surg Sports Traumatol Arthrosc. 2023;31(5):1792–1799. https://doi.org/10.1007/s00167-022-07124-9.
30. Park H.J., Song J.H., Kim K.M. et al. The impact of medial retinacular repair on patellar stability after lateral release in patellofemoral instability patients: a randomized controlled trial. Am J Sports Med. 2021;49(13):3617–3625. https://doi.org/10.1177/03635465211038254.
31. Lee D.Y., Kim J., Park S.J. et al. Evaluation of the effectiveness of percutaneous medial retinacular repair in acute versus recurrent patellar dislocation. Knee Surg Sports Traumatol Arthrosc. 2022;30(10):3470–3477. https://doi.org/10.1007/s00167-022-07000-4.
32. Müller B., Zelle B.A., Kohn D.M. Combined lateral release and medial retinacular repair in recurrent patellar instability: clinical outcomes and risk factors for failure. Orthop J Sports Med. 2023;11(3):23259671231100687. https://doi.org/10.1177/23259671231100687.
33. Fink C., Seitz A., Imhoff F.B. et al. Medial patellofemoral ligament reconstruction using semitendinosus autograft according to the Schöttle technique: clinical outcomes and complications in primary and recurrent patellar instability. Knee Surg Sports Traumatol Arthrosc. 2021;29(9):2767–2775. https://doi.org/10.1007/s00167-020-06167-9.
34. Zhang H., Chen B., Wang W. et al. Clinical outcomes of Elmslie-Trillat procedure combined with lateral release in patients with chronic patellar dislocation. J Orthop Surg Res. 2022;17(1):319. https://doi.org/10.1186/s13018-022-03167-y.
35. Lee G.W., Lee Y.S., Lim T.K., Park Y.U. Long-term outcomes of medialization tibial tubercle transfer (Elmslie-Trillat procedure) for patellar instability. Knee Surg Relat Res. 2021;33(1):27. https://doi.org/10.1186/s43019-021-00094-4.
36. Kim H.J., Park S.Y., Kang J.W. et al. Combined medialization of the tibial tubercle and lateral retinacular release for treatment of chronic lateral patellar dislocation. Clin Orthop Surg. 2023;15(1):56–63. https://doi.org/10.4055/cios21112.
37. González-Herranz P., Plaza-Izquierdo N., Soler-Sánchez I. et al. The efficacy of combined Elmslie-Trillat procedure and lateral release in permanent patellar dislocation: a systematic review. Arch Orthop Trauma Surg. 2021;141(12):2043–2051. https://doi.org/10.1007/s00402-021-04162-9.
Review
For citations:
Komogortsev I.E., Krasovsky A.I., Kalashnikov I.V., Ilin A.A., Urbanov A.G., Namoguruev A.B., Melkostupov A.A., Angarskaya E.G., Komogortseva E.G. SURGICAL TREATMENT OF PERSISTENT AND RECURRENT PATELLAR DISLOCATIONS. Baikal Medical Journal. 2025;4(2):71-78. (In Russ.) https://doi.org/10.57256/2949-0715-2025-4-2-71-78