Allotendoplasty in Treatment of Habitual Patella Dislocation in Adults

Abstract

Background. Habitual dislocation of patella is a congenital disease that manifests in early childhood or adolescent age and requires surgical treatment. In case this condition has not been rectified timely, the congenial patellar luxation develops the properties of a habitual dislocation accompanied by pain syndrome and osteoarthrosis development in the patellofemoral and knee joints. In most cases reconstructive surgery is used for this disease treatment; it is aimed at the strengthening of the knee joint interval compartment, with the formation of a fibrous graſt or a vertical strip of it, which are moved to the knee joint outside compartment and fixed to adjacent tissues with sutures. However, such surgery is possible only in case of preserved anatomic structures of the knee medial compartment. In adult patients, aſter multiple patellar dislocations, the interval joint capsule and medial aponeurosis lose their normal structure, become weakened, strained, and loose. That is why the patient’s own tissues from that area cannot be used for reconstructive surgery.The purpose of the study is to develop the new low-traumatic method of treatment for habitual dislocation of kneecap in adult patients to ensure its reliable stabilization as related to the joint surface on distal femoral epimetaphys, and to prevent patella dislocation relapse.Material and methods. Surgery technique consists of the lateral release of knee joint, mobilization of patellar ligament and its excision together with the fragment of tibial tuberosity osseous. On 1.5–2.0 cm medially from the area of own patellar ligament harvesting in tibia epimetaphys, the new bed with the similar form and shape is formed, and the excised tibial tuberosity fragment with patellar ligament is introduced there and fixed with a Cancellous screw.The area of own patellar ligament harvestingis filled up with autogenous osseous tissue taken from the medial part of tibia epimetaphys when forming the new bed for the excised tibial tuberosity fragment. Transversal tunnelis formedin the quadriceps tendon above the patella; allotendonis pulledvia this tunnel. The allotendon ends are sutured together, thus forming the duplication, analogous to the ligament, and fixit, stretched to “pes anserinus” of the shin onits anterior-interior surface.Conclusion. The new technology of allotendoplasty for the treatment of habitual kneecap dislocation in adult patients facilitates the surgical technique, additionally strengthens medial compartment tissues of the knee, reliably stabilizes the patella as related to its joint surface on distal femoral epimetaphys, eliminates patella dislocation relapse, normalizes the knee and patellofemoral joints functioning by preventing osteoarthrosis progression in them.