Delayed proximal repair and distal realignment after patellar dislocation

Twenty athletes with distal malalignment who sustained unilateral traumatic patellar dislocation remained impaired by chronic instability. Surgery was performed at a mean age of 18 years. Posttraumatic attenuation of the medi al patellofemoral ligament was repaired near the margin of the patella in 1 0 knees and avulsion or attenuation posterior to the vastus medialis obliqu us in 10 knees. Advancement of the medial patellomeniscal ligament at the m argin of the patella and normalization of the Q angle to 10 degrees by tibi al tubercle osteotomy were performed in each knee. Distal lateral retinacul ar release without release of the normal vastus lateralis tendon was perfor med. Results were judged according to Turba et al, and activity levels were evaluated per guidelines of the International Knee Documentation Committee . Eighteen (90%) patients achieved good or excellent results and were unimp aired at a minimum of 24 months. Two patients achieved fair subjective resu lts with some impairment in vigorous activity. There was no recurrent insta bility. Radiographically, the mean preoperative patellofemoral congruence a ngle improved from 20 degrees to 0 degrees. Athletes who sustain an initial traumatic patellar dislocation after physeal closure and in whom conservat ive management fails can be treated successfully by repair of the medial pa tellofemoral ligament at the site of disruption and advancement of the medi al patellomeniscal ligament combined with correction of an elevated Q angle .