TO EVALUATE THE OUTCOME FOLLOWING PROXIMAL REALIGNMENT PROCEDURE FOR HABITUAL PATELLAR DISLOCATION: AN ANALYTICAL STUDY.

Aim: to evaluate outcome following proximal realignment procedure in habitual patellar dislocation. Materials and Methods: prospective comparative study was conducted in the Department of Orthopedics Jawaharlal Nehru Medical College, Bhagalpur from jan 2019 to December 2019 among 18 patients who underwent proximal realignment for habitual patellar dislocation with a minimum follow up of 6 months and a maximum follow up of 2 years. Radiological assessment was done by measuring sulcus angle and congruence angle and pain was assessed using VAS scale. Results: mean age of the study population was 18.64 years and 55.6% were male and rests 44.4 were female. Mean pre and post operative sulcus angle (132.46, 132.58) and Congruence angle (62.86, 17.81). Two the cases showed recurrence. Conclusion: we conclude that following proximal realignment procedure for habitual dislocation of patella radiological parameters were brought back to normal. There were no significant changes in sulcus angle. Keywords: patella, habitual dislocation, outcome, proximal realignment

The Outcomes of Isolated Distal Realignment Procedures in Patellofemoral Instability: A Systematic Review and Meta-analysis

Distal realignment procedures are now commonly performed routinely with proximal realignment procedures. Despite so, only a limited number of publications exist that have looked into the efficacy of isolated distal realignment procedures, and whether there is indeed a need for routine proximal realignment procedures to be added to the distal realignment procedures. The current systematic review and meta-analysis aims to evaluate the outcomes of isolated distal realignment procedures in the management of patellofemoral instability. The review was conducted using the preferred reporting items for systematic reviews and meta-analyses (PRSIMA) guidelines. All studies that reported the outcomes of isolated distal realignment procedures for patellofemoral instability were included. A total of six publications were included, with 347 knees. All studies consistently reported a decrease in the rates of patellofemoral instability or maltracking (odds ratio [OR]: < 0.01; 95% confidence interval [CI]: < 0.01–0.01) and an increase in the odds of having a good outcome (OR: 0.01; 95% CI: < 0.01–0.02) after distal realignment procedures. A total of 24 out of 306 patients (7.8%) had postoperative instability or maltracking, and a total of 220 out of 303 patients (72.6%) were rated to have good or excellent outcomes postoperatively. Isolated distal realignment procedures can lead to good outcomes when used in the management of patellofemoral instability. These include a significantly decreased rate of patellofemoral instability or maltracking and a significantly increased number of patients with excellent or good outcomes postoperatively. Comparisons between patients with and without additional proximal realignment procedures suggest that additional proximal realignment procedures do not definitely improve the outcomes of distal realignment procedures and, therefore, should not be routinely performed in all patients undergoing distal realignment procedures. The Level of Evidence for this study is IV.

Surgical treatment of symptomatic patellofemoral malalignment: Do we need an ideal patellofemoral congruency to solve the symptoms?

Background/Aim. The aim of this prospective nonrandomized study was to test functional results of different surgical strategies in the operative treatment of symptomatic patellofemoral malalignment. Our hypothesis was that immediate extensive surgery does not have serious advantage comparing to ?step by step? procedure, regarding the main symptoms and functional end result. We wanted to check whether obtaining ideal surgical patellofemoral congruency is an essential prerequisite for subsidence of the major symptoms of patellofemoral malalignment. Methods. The study included 35 patients with patellofemoral malalignment who had persistant major symptoms: patellar pain and slipping, 3 months after nonoperative treatment. Divided into three groups, they all underwent the realignment surgery, but in different extent and sequence: immediate extensive surgery, step by step surgery, and only proximal realignment. Their overall functional scores as well as major symptoms were assessed at the beginning, after the surgery, and during the 3-years follow-up period and then, compared at the end. Results. There was no significant difference in the functional results among the groups, neither at the beginning (p = 0.1318) nor at the end of the study (p = 0.3996), but the results at the beginning compared to those at the end of the study showed a statistically significant difference in all three groups (p1 = 0.005062; p2 = 0.011719; p3 = 0.000352). The same result was in regard to the major symptoms. Conclusion. The study confirmed that insisting on immediate extensive surgery in order to achieve precise and complete congruency of the patellofemoral joint, did not prove its advantage over the less invasive, individual surgical approach concerning functional scores and major symptoms.

Tratamiento quirúrgico de la luxación recidivante de rótula en el niño asociada a displasia patello-femoral./ Surgical treatment of recurrent patellar dislocation in children associated with patello-femoral dysplasia

Objetivo:El objetivo del presente trabajo es mostrar los resultados en una serie cortade pacientes con inestabilidad patelo-femoral o luxación recurrente de rótula en niñosoperados con la técnica de realineamiento proximal. La inestabilidad patelo-femoralse define como una enfermedad en la cual no hay suficiente acople de la rótula con latróclea femoral durante el rango de movimiento de la rodilla. En niños esta inestabilidadpuede deberse a diversos factores anatómicos conduciendo a luxación recurrente dela rótula. Hay cirugías sobre la parte proximal o distal de la rótula.Materiales y mé-todos:tratamos una serie de 10 rodillas en 7 niños, con un realineamiento proximalde la rótula según la técnica de Insall.Resultados:se obtuvieron buenos resultadosen 8 rodillas, sin dolor, sin luxación ni inestabilidad residual, presentando buenaestabilidad y seguridad durante la marcha. Un paciente presento reluxación y otrocon Síndrome de Down, presento con el tiempo una subluxación.Conclusiones:Elrealineamiento proximal en esta serie muestra buenos resultados en pacientes quetenían poca displasia troclear y sin mucha alteración del ángulo Q. Es una técnicano muy usada, que tiene indicación en casos escogidos. Hoy en día con el conceptode la reconstrucción del ligamento patelo- femoral medial, este puede ser usado encombinación con las técnicas de realineamiento proximal. Hay que estar alerta conlos pacientes con síndromes que se acompañan de hiperlaxitud como el S. de Down. Objective: The aim of this paper is to show the results in a small series of patients withpatellofemoral instability or recurrent patellar dislocation in children operated with theproximal realignment technique. Materials and methods: It is a series of 10 knees in7 children, with proximal patela realignment patela using the Insall technique. The mostimportant role of the patela is to increase the quadriceps efficiency. The patelo -femoralinstability is defined as a condition in which there is insufficient coupling of the patelawith the femoral trochlea during the knee range of motion. In children this instabilitymay be due to various anatomical factors leading to recurrent dislocation of the patela.There are surgeries proximal o distal to the patela level. Results: Good results wereobtained on 8 knees, without pain, neither dislocation nor residual instability and havinggood stability and safety during the gait. One patient showed redislocation and anotherpatient with Down syndrome had a subluxation. Conclusions: proximal realignment inthis series shows good results in patients who had little trochlear dysplasia with mildalteration of the Q angle. It is a technique not widely used but has indicated in selectedcases. Today, the patelo - femoral medial ligament reconstruction, can be used incombination with proximal realignment techniques. Patients with collagen problemslike Marfan and Down syndrome usually have redislocation and require some otherprocedures for patelar stabilization.