Abstract
Purpose To evaluate the long-term results of classical “à la carte” surgical treatment of
objective patellar instability as proposed by Dejour in 1987.
Methods A multicentric retrospective study was conducted evaluating patients that underwent
surgical procedure with a 10-year minimum follow-up (mean 12.7; range, 10–15). Surgical
procedures were medial transfer of the tibial tubercle transfer according to Elmslie
and Trillat et al in 38 cases, plasty of the vastus medialis obliquus according to
Insall in 15 cases, open lateral retinacular release in 13 cases, capsuloplasty in
3 cases, and trochleoplasty in 1 case. Different combinations of surgical procedures
were adopted according to the pathological features. Subjective outcome was assessed
with the visual analog scale (VAS), Kujala score, subjective International Knee Documentation
Committee (IKDC) score, Tegner score, and Crosby and Insall scale. Radiographic exams
were used to assess the patellar tilt by the Laurin's angle and patellofemoral osteoarthritis
(OA) according to the Iwano radiological OA scale.
Results Forty patients were evaluated. Subjectively, 60% of patients achieved a result judged
good, 34% sufficient, and 6% poor. There were only two cases of recurrence of instability.
Mean score results were Kujala score 73.4 ± 9.9 (range, 55–95), VAS 4.5 ± 1.2 (range,
1–6), IKDC 64.8 ± 7.9 (range, 51–88), and Tegner score 4. Only nine patients returned
to sports activities). Ten patients developed a grade I patellofemoral OA, 8 patients
a grade II, and 22 patients a grade III. Average patellar tilt was 10° ± 3.9°.
Conclusion This retrospective study showed that the traditional surgical procedure was successful
for the treatment of patellar instability, but it did not prevent symptomatic patellofemoral
OA.
Level of Evidence Level IV, retrospective case series.
Keywords
patellar instability - patellofemoral - Elmslie–Trillat - osteoarthritis - tibial
tubercle transfer
