Surgical Treatment of Persistent and Recurrent Patellar Dislocations

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.