Combined Surgical Treatment Of Recurrent Patellardislocation

Background and objectivePatella is the largest sesamoid, is an important part of the extensor mechanism of the human body, its main physiological function is to deliver and strengthen the quads, maintaining the stability of the knee and protect the articular surface of the femur. Patella femoral condyle geometry, joint static nature of the patellar tendon and ligament balance, balance of power type quadriceps strength and around the outside of the capsule to maintain the stability of the patella. When congenital or acquired factors, traumatic damage to the balance around the patella can shift occurred dislocation, subluxation or tilt. Patella can move in all directions, due to its biomechanical characteristics, is the most common clinical lateral displacement, and easy to relapse. Recurrent patellar dislocation is common in post-traumatic patellar dislocation, most patients due to an external force re-dislocation, and finally only slight twist or stretch due to dislocation. More common in women, may be associated with excessive ligament laxity concerning women, and most of them have significant family history, bilateral disease, accounting for 1/3 of a good age from 15 to 17 years old. Patients mainly for recurrent patellar dislocation around the patella dull, increasing pressure on the patellofemoral joint activities will make the pain got worse, such as up and down stairs and squatting. Many patients have knee weakness, can not hold "playing soft legs," sudden activity ineffective and even fall in history, some cases of joint swelling, can be manifested as interlocking. The longer the duration, the more serious the damage caused by the dislocation, should be actively treated, otherwise it will lead to a series of complications, such as synovial thickening, patellar cartilage degeneration, osteoarthritis, osteochondral loose bodies, limbs decreased exercise capacity, chase around the knee muscle atrophy occur gradually. Seriously affect the normal development of the patient’s daily activities and the knee, with a high therapeutic value. Recurrent patellar dislocation non-surgical treatment is poor, for mild, refused surgery or in patients with contraindications feasible quadriceps strengthening exercises to reduce the load of the patellofemoral joint activities, such as wearing knee pads. Severe symptoms of osteoarthritis, with non-steroidal anti-inflammatory pain medication. Most require surgery. Factors related to the disease pathology and anatomical many, including the inside of the support with relaxation, with a tight lateral support, outside of the patella and femoral condyle developmental abnormalities. The surgical procedure included soft tissue balancing and bone surgery, soft tissue surgery is widely used is the lateral support band release, medial belt tightening, but reportedly has a high recurrence rate of this method. And recurrent dislocation of the patella more associated with cartilage damage, the knee meniscus injury and other diseases, leading to the formation of osteoarthritis of the knee loose bodies affect the life, using a single surgical treatment can not achieve good curative effect. By retrospective analysis, we used arthroscopic exploration and treatment, cut the release lateral support belt tightening belts and medial tibial tubercle transfer operation combined treatment of recurrent dislocation of the patella, which deal with the cartilage, bone cartilage damage; also You can adjust the lines of force of the patella and extensor mechanism reconstruction, improving the position of the patella, reducing the lateral patellofemoral joint stress and lateral support band peripheral nerve tension, thus extending the life of the knee, prevention and treatment of patellofemoral arthritis. Complex anatomical factors, coupled with the mechanism of dislocation is not uniform, so there are differences on treatment. Currently there is no clear, unified clinical "gold standard" procedure, a single surgery and conservative treatment can not achieve a satisfactory effect, this study analyzed retrospectively investigate the treatment of recurrent dislocation of the patella efficacy combined surgery. Objects and methodsA retrospective analysis was performed using arthroscopic exploration and treatment, cut the release lateral support belt tightening and shifting technique with medial tibial tuberosity treat 42 cases of recurrent patellar dislocation clinical data. There were 10 males and 25 females, 18 cases left knee. Right knee 24 cases, aged 16-28 years old, 3-9 times the number of dislocation, dislocation of both the initial trauma. Preoperative examination revealed passive patellar tilt test was positive, the lateral patella sliding test positive, Q angle measurement is greater than the normal range, are routine preoperative radiographs of the knee, axial slices and MRI. For recurrent patellar dislocation history, the epiphyseal growth plates have closed or have passed the peak femoral condyle patients without severe dysplasia using joint surgery. Postoperative follow-up questionnaires, using the Lysholm and Tegner subjective assessment scoring system for preoperative and postoperative scores, including an objective assessment of patellar stability tests and imaging studies as well as the patient’s pain, snapping, locking, swelling, and the overall function of the limb rehabilitation. Using SPSS17.0 statistical software for analysis, data are mean ± standard deviation(x ± s) that the groups were compared using paired t test. With P <0.05 was considered statistically significant. Result42 cases were followed up for 24 to 30 months, after the Q angle returned to the normal range, imaging and medical review after patellar stability, subjective ratings and motor function: Lysholm score preoperative(48.83 ± 6.07) points, postoperative(88.09 ± 5.13) min(P <0.05), Tegner scores before surgery(3.80 ± 1.40) points postoperatively(6.71 ± 1.01) min(P <0.05). Significant symptom relief, improved significantly compared with the preoperative activity level, 40 cases(95.2%) returned to normal, while 2 cases(4.8%) sports occasional discomfort. ConclusionCompared with conservative treatment and a single surgery, arthroscopic exploration and treatment, cut the release lateral support belt, tightening belts and medial tibial tubercle transfer operation combined treatment of recurrent dislocation of the patella, which deal with the cartilage, bone cartilage the damage; they can adjust the lines of force of the patella and extensor mechanism reconstruction, improving the position of the patella, reducing the lateral patellofemoral joint stress and lateral support band peripheral nerve tension, thus extending the life of the knee, prevention and treatment of patellofemoral arthritis. To achieve an operation to solve all problems, reducing the relapse rate in patients and reoperation rates, not only reduces the burden on the economy from the patient and help to improve the health and quality of life of patients. And easy to operate, easy to grasp and effective. The study group was only short-term follow-up results, long-term prognosis remains to be seen.