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Gracilis tendon transfer associated with distal alignment for patella alta with recurrent dislocations: an original surgical technique.
[trochlear dysplasia]
Many
surgical
techniques
for
the
medial
patellofemoral
ligament
have
recently
been
suggested
,
all
of
which
included
problems
identifying
the
femoral
anchorage
point
and
determining
the
proper
extent
of
knee
flexion
for
the
transplant
.
P
.
Burdin
proposed
a
different
and
original
approach
consisting
in
performing
a
gracilis
muscle
transfer
to
the
medial
edge
of
the
patella
,
thus
obtaining
progressive
tension
of
the
transfer
during
knee
flexion
by
means
of
the
myotatic
reflex
.
We
report
the
results
herein
.
We
retrospectively
assessed
17
knees
treated
for
patellofemoral
instability
using
this
technique
.
Two
cases
presented
subjective
patellofemoral
instability
and
15
presented
objective
patellofemoral
instability
.
The
patients
'
mean
age
was
17
.
4
years
(
range
,
8
-
47
years
)
during
the
first
episode
of
dislocation
.
Two
cases
of
instability
were
secondary
to
advanced
neuromuscular
disease
.
Two
knees
had
already
undergone
two
stabilization
attempts
.
Fifteen
knees
presented
trochlear
dysplasia
(
four
stage
A
,
eight
stage
B
,
and
three
stage
C
)
.
The
mean
age
at
surgery
was
28
.
2
years
(
range
,
16
-
47
years
)
.
In
15
cases
,
the
gracilis
transfer
was
associated
with
lowering
the
anterior
tibial
tuberosity
(
mean
,
10
mm
)
.
No
patellar
fracture
occurred
.
A
persistent
sensory
deficit
of
the
anterior
branch
of
the
internal
saphenous
nerve
was
observed
in
15
cases
.
One
knee
remained
painful
and
retained
subjective
instability
;
total
knee
arthroplasty
was
performed
3
years
after
the
intervention
.
The
mean
follow-up
at
revision
was
5
.
5
years
(
range
,
1
.
5
-
16
.
5
years
)
.
No
recurrence
of
dislocation
was
reported
.
Eight
cases
retained
subjective
instability
.
The
SF-
36
and
IKDC
scores
were
good
or
excellent
in
12
cases
and
the
KOOS
was
good
or
excellent
in
13
cases
.
Radiologically
,
patellar
tilt
persisted
in
six
cases
out
of
14
,
translation
persisted
in
two
cases
out
of
14
,
and
secondary
patella
baja
was
observed
in
one
.
Medial
patellofemoral
osteoarthritis
was
observed
in
five
cases
:
one
case
IWANO
stage
I
and
four
cases
IWANO
stage
II
.
These
satisfactory
results
seem
stable
over
time
and
were
acquired
using
a
simple
procedure
with
reduced
morbidity
,
making
it
possible
to
avoid
significant
displacement
of
the
anterior
tibial
tuberosity
and
stabilize
the
extensor
apparatus
.
It
can
also
be
hoped
that
the
onset
of
secondary
patellofemoral
osteoarthritis
,
undoubtedly
inevitable
,
has
been
delayed
.
Diseases
Validation
Diseases presenting
"stabilize the extensor apparatus"
symptom
trochlear dysplasia
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