Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Archives of Orthopaedic and Trauma Surgery
Published in: Archives of Orthopaedic and Trauma Surgery 10/2020

01-10-2020 | Orthopaedic Surgery

High failure rate 10.8 years after vastus medialis transfer and lateral release (Green’s quadricepsplasty) for recurrent dislocation of the patella

Authors: Alexander Vacariu, Kathrin Studer, Erich Rutz, Carlo Camathias

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 10/2020

Login to get access

Abstract

Purpose

In adolescent patients with recurrent patellar dislocation, the Green’s quadricepsplasty stabilizes the patella in a combination of a lateral release, a transfer of the medial head of the quadriceps onto the lateral part of the patella and an imbrication of the medial patellar retinaculum and joint capsule. This study aimed to evaluate the long-term performance, considering re-dislocations and functional outcomes. We hypothesized a high failure rate in the long term.

Methods

In this single surgeon and single center study 26 knees in 23 patients (mean age 14.2 years; 4–22 years, 18 females) with recurrent patellofemoral dislocation underwent a vastus medialis transfer, medial reefing and lateral release as it was described by Green in 1965 with a mean follow-up 10.8 years (6–24 years). Clinical assessment was carried out with an IKDC-score (international knee documentation committee) and a self-assessment for each knee separately. The radiologic evaluation included measurement of the patella height, the grade of trochlear dysplasia and the sulcus angle.

Results

In 12 of 26 cases (46.2%) the patella did not re-dislocate after vastus medialis transfer and lateral release. In 11 of 26 cases (42.3%), the patients described the function of their knees as normal or nearly normal according to IKDC after the surgical treatment without any re-dislocation. In 14 of 26 cases (53.8%), the patella re-dislocated. 7 of these 14 cases underwent a revision operation. Re-dislocations occurred after a mean interval of 21 months after the index procedure. In only 2 of 26 cases (7.7%) the patients returned to sports.

Conclusion

Green’s procedure to stabilize patellofemoral instabilities results in a high failure rate on the long-term and low subjective assessments. We do not recommend performing vastus medialis transfer, medial imbrication and lateral release as a standalone technique.

Level of evidence

IV.
Literature
1.
2.
Buchner M, Baudendistel B, Sabo D, Schmitt H (2005) Acute traumatic primary patellar dislocation: long-term results comparing conservative and surgical treatment. Clin J Sport Med 15:62–66CrossRef
3.
Camathias C, Rutz E, Gotze M, Brunner R, Vavken P, Gaston MS (2014) Poor outcome at 7.5 years after Stanisavljevic quadriceps transposition for patello-femoral instability. Arch Orthop Trauma Surg 134:473–478CrossRef
4.
Camathias C, Speth BM, Rutz E, Schlemmer T, Papp K, Vavken P et al (2018) Solitary trochleoplasty for treatment of recurrent patellar dislocation. JBJS Essent Surg Tech 8:e11CrossRef
5.
Camathias C, Studer K, Kiapour A, Rutz E, Vavken P (2016) Trochleoplasty as a solitary treatment for recurrent patellar dislocation results in good clinical outcome in adolescents. Am J Sports Med 44:2855–2863CrossRef
6.
Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H (1982) Patella infera. Apropos of 128 cases. Rev Chir Orthop Reparatrice Appar Mot 68:317–325PubMed
7.
Christoforakis J, Bull AM, Strachan RK, Shymkiw R, Senavongse W, Amis AA (2006) Effects of lateral retinacular release on the lateral stability of the patella. Knee Surg Sports Traumatol Arthrosc 14:273–277CrossRef
8.
Colvin AC, West RV (2008) Patellar instability. J Bone Jt Surg Am 90:2751–2762CrossRef
9.
Dejour H, Walch G, Neyret P, Adeleine P (1990) Dysplasia of the femoral trochlea. Rev Chir Orthop Reparatrice Appar Mot 76:45–54PubMed
10.
Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26CrossRef
11.
Desio SM, Burks RT, Bachus KN (1998) Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 26:59–65CrossRef
12.
Dickschas J, Ferner F, Lutter C, Gelse K, Harrer J, Strecker W (2018) Patellofemoral dysbalance and genua valga: outcome after femoral varisation osteotomies. Arch Orthop Trauma Surg 138:19–25CrossRef
13.
Dickschas J, Tassika A, Lutter C, Harrer J, Strecker W (2017) Torsional osteotomies of the tibia in patellofemoral dysbalance. Arch Orthop Trauma Surg 137:179–185CrossRef
14.
Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA et al (2004) Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 32:1114–1121CrossRef
15.
Fitzpatrick CK, Steensen RN, Tumuluri A, Trinh T, Bentley J, Rullkoetter PJ (2016) Computational analysis of factors contributing to patellar dislocation. J Orthop Res 34:444–453CrossRef
16.
Frosch KH, Schmeling A (2016) A new classification system of patellar instability and patellar maltracking. Arch Orthop Trauma Surg 136:485–497CrossRef
17.
Frosch S, Balcarek P, Walde TA, Schuttrumpf JP, Wachowski MM, Ferleman KG et al (2011) The treatment of patellar dislocation: a systematic review. Z Orthop Unfall 149:630–645CrossRef
18.
Green WT (1965) Recurrent dislocation of the patella: its surgical correction in the growing child. J Bone Jt Surg Am 47:1670–1675
19.
20.
Hefti F, Muller W, Jakob RP, Staubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1:226–234CrossRef
21.
Herring JA (2013) Tachdjian's pediatric orthopaedics e-book: from the Texas Scottish Rite hospital for children, 5th edn. Elsevier Health Sciences, Amsterdam
22.
Hohne S, Gerlach K, Irlenbusch L, Schulz M, Kunze C, Finke R (2017) Patella dislocation in children and adolescents. Z Orthop Unfall 155:169–176CrossRef
23.
Kocon H, Kabacyj M, Zgoda M (2012) The results of the operative treatment of patellar instability in children with Down's syndrome. J Pediatr Orthop B 21:407–410CrossRef
24.
Kohlitz T, Scheffler S, Jung T, Hoburg A, Vollnberg B, Wiener E et al (2013) Prevalence and patterns of anatomical risk factors in patients after patellar dislocation: a case control study using MRI. Eur Radiol 23:1067–1074CrossRef
25.
Lippacher S, Dreyhaupt J, Williams SR, Reichel H, Nelitz M (2014) Reconstruction of the medial patellofemoral ligament: clinical outcomes and return to sports. Am J Sports Med 42:1661–1668CrossRef
26.
Madigan R, Wissinger HA, Donaldson WF (1975) Preliminary experience with a method of quadricepsplasty in recurrent subluxation of the patella. J Bone Jt Surg Am 57:600–607CrossRef
27.
Merchant AC, Mercer RL, Jacobsen RH, Cool CR (1974) Roentgenographic analysis of patellofemoral congruence. J Bone Jt Surg Am 56:1391–1396CrossRef
28.
Palmu S, Kallio PE, Donell ST, Helenius I, Nietosvaara Y (2008) Acute patellar dislocation in children and adolescents: a randomized clinical trial. J Bone Jt Surg Am 90:463–470CrossRef
29.
Panagiotopoulos E, Strzelczyk P, Herrmann M, Scuderi G (2006) Cadaveric study on static medial patellar stabilizers: the dynamizing role of the vastus medialis obliquus on medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 14:7–12CrossRef
30.
31.
Rhee SJ, Pavlou G, Oakley J, Barlow D, Haddad F (2012) Modern management of patellar instability. Int Orthop 36:2447–2456CrossRef
32.
Rouanet T, Gougeon F, Fayard JM, Remy F, Migaud H, Pasquier G (2015) Sulcus deepening trochleoplasty for patellofemoral instability: a series of 34 cases after 15 years postoperative follow-up. Orthop Traumatol Surg Res 101:443–447CrossRef
33.
34.
Shah JN, Howard JS, Flanigan DC, Brophy RH, Carey JL, Lattermann C (2012) A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 40:1916–1923CrossRef
35.
Smith TO, Song F, Donell ST, Hing CB (2011) Operative versus non-operative management of patellar dislocation. A meta-analysis. Knee Surg Sports Traumatol Arthrosc 19:988–998CrossRef
36.
Stefancin JJ, Parker RD (2007) First-time traumatic patellar dislocation: a systematic review. Clin Orthop Relat Res 455:93–101CrossRef
37.
Tachdjian MO (1972) Pediatric orthopaedics, vol 1. W.B.Saunders, Philadelphia
38.
Vavken P, Wimmer MD, Camathias C, Quidde J, Valderrabano V, Pagenstert G (2013) Treating patella instability in skeletally immature patients. Arthroscopy 29:1410–1422CrossRef
39.
von Knoch F, Bohm T, Burgi ML, von Knoch M, Bereiter H (2006) Trochleaplasty for recurrent patellar dislocation in association with trochlear dysplasia. A 4- to 14-year follow-up study. J Bone Jt Surg Br 88:1331–1335CrossRef
40.
Weeks KD 3rd, Fabricant PD, Ladenhauf HN, Green DW (2012) Surgical options for patellar stabilization in the skeletally immature patient. Sports Med Arthrosc 20:194–202PubMed
41.
Zhao J, Huangfu X, He Y, Liu W (2012) Recurrent patellar dislocation in adolescents: medial retinaculum plication versus vastus medialis plasty. Am J Sports Med 40:123–132CrossRef
Metadata
Title
High failure rate 10.8 years after vastus medialis transfer and lateral release (Green’s quadricepsplasty) for recurrent dislocation of the patella
Authors
Alexander Vacariu
Kathrin Studer
Erich Rutz
Carlo Camathias
Publication date
01-10-2020
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 10/2020
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-019-03322-4

Other articles of this Issue 10/2020

Archives of Orthopaedic and Trauma Surgery 10/2020 Go to the issue

Knee Arthroplasty

Maximal flexion and patient outcomes after TKA, using a bicruciate-stabilizing design

Trauma Surgery

Does cement augmentation of the screws in angular stable plating for proximal humerus fractures influence the radiological outcome: a retrospective assessment

Trauma Surgery

Local osteo-enhancement of osteoporotic vertebra with a triphasic bone implant material increases strength—a biomechanical study

Trauma Surgery

Outcomes after implementation of an open fracture clinical pathway

Knee Arthroplasty

Clinical outcome of bi-unicompartmental knee arthroplasty for both medial and lateral femorotibial arthritis: a systematic review—is there proof of concept?

Arthroscopy and Sports Medicine

Quadriceps tendon vs. patellar tendon autograft for ACL reconstruction using a hardware-free press-fit fixation technique: comparable stability, function and return-to-sport level but less donor site morbidity in athletes after 10 years