The three-in-one proximal and distal soft tissue patellar realignment procedure - Results, and its place in the management of patellofemoral instability

The three-in-one procedure for extensor mechanism realignment of the knee c ombines lateral release, vastus medialis obliquus muscle advancement, and t ransfer of the medial one-third of the patellar tendon to the tibial collat eral ligament. We observed 37 patients (42 knees) receiving this treatment at a minimum 25-month follow-up (range, 25 to 85 months; mean, 44). Thirty- two of 42 knees (76%) with recurrent patellar dislocation had good or excel lent results after surgery. Redislocation occurred in four knees (9.5%). Sk eletal immaturity, chondral damage, and generalized ligament laxity did not seem to affect outcome. Thirty patients (37 knees) were studied 2 years ea rlier as well (mean follow-up, 29 months). When comparing the results 2 yea rs later, there was a significant deterioration in outcome over time. These results are comparable with the published results for other techniques of patellar stabilization. We describe the place of the three-in-one operation in our surgical protocol for patellofemoral instability which is based on the principle that a procedure should be selected to address the underlying pathologic features in an individual case rather than always using one ope ration for all cases.