Surgical Treatment Of Habitual Dislocation Of The Patella
![Surgical Treatment Of Habitual Dislocation Of The Patella In Young Children: A 13 Year Surgical Treatment Of Habitual Dislocation Of The Patella In Young Children: A 13 Year](https://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-1.jpg)
Surgical Treatment Of Habitual Dislocation Of The Patella In Young Children: A 13 Year Follow-up Retrospective Study Benoit, MD Yves Laflamme, MD Benoit Morin, MD Guy Grimard, MD Dominique Rouleau, MD
![Habitual Patellar Dislocation = Severe Functional Disability Habitual Patellar Dislocation = Severe Functional Disability](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-2.jpg)
Habitual Patellar Dislocation = Severe Functional Disability
![Habitual Patellar Dislocation Ø Dislocation occurs with activities of daily living Ø Sporting activities Habitual Patellar Dislocation Ø Dislocation occurs with activities of daily living Ø Sporting activities](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-3.jpg)
Habitual Patellar Dislocation Ø Dislocation occurs with activities of daily living Ø Sporting activities are almost impossible
![Factors* Of Patellar Instability (Six) *Insall and Salvati, 2001 Factors* Of Patellar Instability (Six) *Insall and Salvati, 2001](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-4.jpg)
Factors* Of Patellar Instability (Six) *Insall and Salvati, 2001
![Factors of patellar instability 1) Patella alta A L T A Factors of patellar instability 1) Patella alta A L T A](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-5.jpg)
Factors of patellar instability 1) Patella alta A L T A
![Radiologic Patellar Height Assessment In The Immature Patient l Koshino-Sugimoto l Caton-Deschamps Radiologic Patellar Height Assessment In The Immature Patient l Koshino-Sugimoto l Caton-Deschamps](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-6.jpg)
Radiologic Patellar Height Assessment In The Immature Patient l Koshino-Sugimoto l Caton-Deschamps
![FF PT/FT = 1 P P T Koshino-Sugimoto FF PT/FT = 1 P P T Koshino-Sugimoto](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-7.jpg)
FF PT/FT = 1 P P T Koshino-Sugimoto
![P AT/PA: 0. 6 -1. 3 P A A T T Caton-Deschamps P AT/PA: 0. 6 -1. 3 P A A T T Caton-Deschamps](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-8.jpg)
P AT/PA: 0. 6 -1. 3 P A A T T Caton-Deschamps
![Factors of patellar instability 2) Hypoplastic Femoral Sulcus 160° Factors of patellar instability 2) Hypoplastic Femoral Sulcus 160°](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-9.jpg)
Factors of patellar instability 2) Hypoplastic Femoral Sulcus 160°
![N = 138° > 150° = Trochlear dysplasia N = 138° > 150° = Trochlear dysplasia](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-10.jpg)
N = 138° > 150° = Trochlear dysplasia
![Factors of patellar instability 3) Patellar Dysplasia Wiberg Classification Factors of patellar instability 3) Patellar Dysplasia Wiberg Classification](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-11.jpg)
Factors of patellar instability 3) Patellar Dysplasia Wiberg Classification
![Factors of patellar instability 4) Muscle Imbalance (VMO dysplasia) Factors of patellar instability 4) Muscle Imbalance (VMO dysplasia)](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-12.jpg)
Factors of patellar instability 4) Muscle Imbalance (VMO dysplasia)
![Factors of patellar instability 5) Increased Q angle Factors of patellar instability 5) Increased Q angle](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-13.jpg)
Factors of patellar instability 5) Increased Q angle
![Factors of patellar instability 6) Lower Limb Malalignment Factors of patellar instability 6) Lower Limb Malalignment](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-14.jpg)
Factors of patellar instability 6) Lower Limb Malalignment
![Treatment options? Treatment options?](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-15.jpg)
Treatment options?
![Ø No study addresses specifically habitual patellar dislocation in the young child Ø No study addresses specifically habitual patellar dislocation in the young child](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-16.jpg)
Ø No study addresses specifically habitual patellar dislocation in the young child
![Treatment Options Ø Conservative l Physical therapy l Knee bracing Ø Surgical Treatment Options Ø Conservative l Physical therapy l Knee bracing Ø Surgical](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-17.jpg)
Treatment Options Ø Conservative l Physical therapy l Knee bracing Ø Surgical
![Does knee bracing prevent habitual patellar dislocation ? Does knee bracing prevent habitual patellar dislocation ?](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-18.jpg)
Does knee bracing prevent habitual patellar dislocation ?
![Does physical therapy prevent habitual patellar dislocation ? Does physical therapy prevent habitual patellar dislocation ?](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-19.jpg)
Does physical therapy prevent habitual patellar dislocation ?
![](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-20.jpg)
![Recurrence rate: 40% + Garth, Am J Sports Med, 1996 Recurrence rate: 40% + Garth, Am J Sports Med, 1996](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-21.jpg)
Recurrence rate: 40% + Garth, Am J Sports Med, 1996
![Ø Surgical treatment Ø Surgical treatment](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-22.jpg)
Ø Surgical treatment
![Literature “Patella alta must absolutely be treated to obtain a satisfactory result” Caton, J. Literature “Patella alta must absolutely be treated to obtain a satisfactory result” Caton, J.](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-23.jpg)
Literature “Patella alta must absolutely be treated to obtain a satisfactory result” Caton, J. Revue Chir. Ortho. , 1990 A L T A
![Literature “Most common technical error in distal realignment is failure to correct patellar height” Literature “Most common technical error in distal realignment is failure to correct patellar height”](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-24.jpg)
Literature “Most common technical error in distal realignment is failure to correct patellar height” Insall J. , JBJS, 1976 Scuderi G. R. , OCNA, 1992 A L T A
![Distal realignment ØExcessive medialization ØPosterior recessing Late osteoarthritis Insall, JBJS, 1976 Distal realignment ØExcessive medialization ØPosterior recessing Late osteoarthritis Insall, JBJS, 1976](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-25.jpg)
Distal realignment ØExcessive medialization ØPosterior recessing Late osteoarthritis Insall, JBJS, 1976
![Surgical Options In The Patient With Open Physis Ø Roux-Golthwait Ø Galeazzi Surgical Options In The Patient With Open Physis Ø Roux-Golthwait Ø Galeazzi](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-26.jpg)
Surgical Options In The Patient With Open Physis Ø Roux-Golthwait Ø Galeazzi
![Roux. Goldthwait Roux. Goldthwait](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-27.jpg)
Roux. Goldthwait
![Galeazzi Galeazzi](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-28.jpg)
Galeazzi
![Roux-Goldthwait VS Galeazzi P A T E L L A A L T A Roux-Goldthwait VS Galeazzi P A T E L L A A L T A](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-29.jpg)
Roux-Goldthwait VS Galeazzi P A T E L L A A L T A
![Roux-Goldthwait Galeazzi P A T E L L A A L T A Roux-Goldthwait Galeazzi P A T E L L A A L T A](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-30.jpg)
Roux-Goldthwait Galeazzi P A T E L L A A L T A
![Bony procedures not appropriate Elmslie-Trillat Fulkerson Bony procedures not appropriate Elmslie-Trillat Fulkerson](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-31.jpg)
Bony procedures not appropriate Elmslie-Trillat Fulkerson
![Tibial tubercule transfer on the knee with open physis Genu recurvatum Tibial tubercule transfer on the knee with open physis Genu recurvatum](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-32.jpg)
Tibial tubercule transfer on the knee with open physis Genu recurvatum
![](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-33.jpg)
![](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-34.jpg)
![](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-35.jpg)
![](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-36.jpg)
![Goal of our study Clinical evaluation of a new procedure to correct patella alta Goal of our study Clinical evaluation of a new procedure to correct patella alta](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-37.jpg)
Goal of our study Clinical evaluation of a new procedure to correct patella alta in children with patellar instability Long term follow-up (13. 8 years)
![Materials and methods Ø Retrospective study Materials and methods Ø Retrospective study](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-38.jpg)
Materials and methods Ø Retrospective study
![Materials and methods Ø Retrospective study Ø 12 consecutive knees treated surgically in young Materials and methods Ø Retrospective study Ø 12 consecutive knees treated surgically in young](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-39.jpg)
Materials and methods Ø Retrospective study Ø 12 consecutive knees treated surgically in young children from 1988 to 1994
![Materials and methods Ø Retrospective study Ø 12 knees in young children treated surgically Materials and methods Ø Retrospective study Ø 12 knees in young children treated surgically](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-40.jpg)
Materials and methods Ø Retrospective study Ø 12 knees in young children treated surgically Ø Follow-up: 10 -17 years (mean 13. 8 years)
![Materials and methods Ø Retrospective study Ø 12 knees in young children treated surgically Materials and methods Ø Retrospective study Ø 12 knees in young children treated surgically](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-41.jpg)
Materials and methods Ø Retrospective study Ø 12 knees in young children treated surgically Ø Follow-up: 10 -17 years (mean 13. 8 years) Ø Mean age at surgery: 10 years 14 years) (6 -
![Materials and methods Ø Retrospective study Ø 12 knees in young children treated surgically Materials and methods Ø Retrospective study Ø 12 knees in young children treated surgically](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-42.jpg)
Materials and methods Ø Retrospective study Ø 12 knees in young children treated surgically Ø Follow-up: 10 -17 years (mean 13. 8 years) Ø Mean age at surgery: 10 years (6 -14 years) Ø Mean age at last follow-up: 25 years
![Materials and methods Ø Inclusion criterias l Habitual patellar dislocation l Functional limitations in Materials and methods Ø Inclusion criterias l Habitual patellar dislocation l Functional limitations in](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-43.jpg)
Materials and methods Ø Inclusion criterias l Habitual patellar dislocation l Functional limitations in activities of daily living l Symptoms of more than 1 year duration
![l Failure of conservative treatment (bracing and physical therapy) l Growth plates opened at l Failure of conservative treatment (bracing and physical therapy) l Growth plates opened at](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-44.jpg)
l Failure of conservative treatment (bracing and physical therapy) l Growth plates opened at time of surgery
![Materials and methods Preoperative clinical evaluation l High-riding patella l VMO dysplasia l Normal Materials and methods Preoperative clinical evaluation l High-riding patella l VMO dysplasia l Normal](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-45.jpg)
Materials and methods Preoperative clinical evaluation l High-riding patella l VMO dysplasia l Normal Q-angle l Positive apprehension test l Lateral patellar laxity IV/IV
![Radiographic measures Ø Sulcus angle Ø Patellar height Radiographic measures Ø Sulcus angle Ø Patellar height](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-46.jpg)
Radiographic measures Ø Sulcus angle Ø Patellar height
![Surgical technique Proximal realignment: üLateral release Hughston technique üVMO advancement Distal realignment: üComplete patellar Surgical technique Proximal realignment: üLateral release Hughston technique üVMO advancement Distal realignment: üComplete patellar](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-47.jpg)
Surgical technique Proximal realignment: üLateral release Hughston technique üVMO advancement Distal realignment: üComplete patellar tendon lowering NEW!
![Patellar tendon dissection Tibial tubercule Patellar tendon Templated advancement: 2. 5 cm Patellar tendon dissection Tibial tubercule Patellar tendon Templated advancement: 2. 5 cm](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-48.jpg)
Patellar tendon dissection Tibial tubercule Patellar tendon Templated advancement: 2. 5 cm
![Patellar tendon elevation Tendon Tibial tubercle Patellar tendon elevation Tendon Tibial tubercle](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-49.jpg)
Patellar tendon elevation Tendon Tibial tubercle
![Tendon preparation Receiving bed Transosseous sutures Tendon preparation Receiving bed Transosseous sutures](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-50.jpg)
Tendon preparation Receiving bed Transosseous sutures
![Distal tendon transfer Distal tendon transfer](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-51.jpg)
Distal tendon transfer
![Tendon attached Tendon attached](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-52.jpg)
Tendon attached
![Results Results](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-53.jpg)
Results
![Ø Mean patellar tendon lowering: 1. 6 cm (1 cm to 2. 5 cm) Ø Mean patellar tendon lowering: 1. 6 cm (1 cm to 2. 5 cm)](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-54.jpg)
Ø Mean patellar tendon lowering: 1. 6 cm (1 cm to 2. 5 cm)
![Results Last follow-up Ø Instability: 0/12 Ø Pain: 1/12 Results Last follow-up Ø Instability: 0/12 Ø Pain: 1/12](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-55.jpg)
Results Last follow-up Ø Instability: 0/12 Ø Pain: 1/12
![Results Last follow-up Ø Lateral glide test Normal in 11/12 Ø Apprehension test Results Last follow-up Ø Lateral glide test Normal in 11/12 Ø Apprehension test](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-56.jpg)
Results Last follow-up Ø Lateral glide test Normal in 11/12 Ø Apprehension test
![Results Lysholm knee score at last follow-up: Ø Mean: 98/100 Results Lysholm knee score at last follow-up: Ø Mean: 98/100](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-57.jpg)
Results Lysholm knee score at last follow-up: Ø Mean: 98/100
![Results Recreational activities Preop Last f-up (13. 8 y) Limited 12/12 1/12 Results Recreational activities Preop Last f-up (13. 8 y) Limited 12/12 1/12](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-58.jpg)
Results Recreational activities Preop Last f-up (13. 8 y) Limited 12/12 1/12
![Results Sulcus Angle Preop 6 m 3. 8 y 13. 8 y Mean 160° Results Sulcus Angle Preop 6 m 3. 8 y 13. 8 y Mean 160°](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-59.jpg)
Results Sulcus Angle Preop 6 m 3. 8 y 13. 8 y Mean 160° 157° 147°
![Results Patellar Height Mean Patellar Height (Caton. Deschamps) N: 0. 6 -1. 3 Preop Results Patellar Height Mean Patellar Height (Caton. Deschamps) N: 0. 6 -1. 3 Preop](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-60.jpg)
Results Patellar Height Mean Patellar Height (Caton. Deschamps) N: 0. 6 -1. 3 Preop 6 m 3. 8 y 1. 53 0. 96 0. 97 1. 11
![Early postoperative complications (3) Ø 1 redislocation (undercorrection) l l Early reoperation Now stable Early postoperative complications (3) Ø 1 redislocation (undercorrection) l l Early reoperation Now stable](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-61.jpg)
Early postoperative complications (3) Ø 1 redislocation (undercorrection) l l Early reoperation Now stable Ø 1 wound abcess l l Surgical drainage, Antibiotics Healed Ø 1 peroneal nerve neurapraxia l l Recovered completely Cast compression?
![Late postoperative complications Ø Two patella bajas (Caton ratio) in children operated at 6 Late postoperative complications Ø Two patella bajas (Caton ratio) in children operated at 6](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-62.jpg)
Late postoperative complications Ø Two patella bajas (Caton ratio) in children operated at 6 and 7 years old
![Discussion Discussion](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-63.jpg)
Discussion
![Discussion Risks of osteoarthritis minimized by: Ø no unnecessary medialization Ø no posterior recessing Discussion Risks of osteoarthritis minimized by: Ø no unnecessary medialization Ø no posterior recessing](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-64.jpg)
Discussion Risks of osteoarthritis minimized by: Ø no unnecessary medialization Ø no posterior recessing Ø high rate of patellofemoral stability
![Discussion Anatomic repositioning of the patella Ø eliminates delay of patellar engagement Ø maximizes Discussion Anatomic repositioning of the patella Ø eliminates delay of patellar engagement Ø maximizes](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-65.jpg)
Discussion Anatomic repositioning of the patella Ø eliminates delay of patellar engagement Ø maximizes buttressing effect of the lateral condyle, and…
![…seems to remodel the shallow throchlea in the immature patient …seems to remodel the shallow throchlea in the immature patient](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-66.jpg)
…seems to remodel the shallow throchlea in the immature patient
![Conclusion Ø Realistic goals were achieved: l Functional knee stability l Return to active Conclusion Ø Realistic goals were achieved: l Functional knee stability l Return to active](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-67.jpg)
Conclusion Ø Realistic goals were achieved: l Functional knee stability l Return to active life
![Conclusion Ø Addressing patellar height is paramount in the immature patient Conclusion Ø Addressing patellar height is paramount in the immature patient](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-68.jpg)
Conclusion Ø Addressing patellar height is paramount in the immature patient
![Conclusion Ø Patella baja occurred in two patients l No clinical or radiological consequence Conclusion Ø Patella baja occurred in two patients l No clinical or radiological consequence](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-69.jpg)
Conclusion Ø Patella baja occurred in two patients l No clinical or radiological consequence l Consequences in the futur? ?
![Conclusion Ø Trochlear remodeling occurs secondary to distal tendon transfer in the immature patient Conclusion Ø Trochlear remodeling occurs secondary to distal tendon transfer in the immature patient](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-70.jpg)
Conclusion Ø Trochlear remodeling occurs secondary to distal tendon transfer in the immature patient
![Thank you Thank you](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-71.jpg)
Thank you
![Who is right? Caton normal Insall: Patella baja Who is right? Caton normal Insall: Patella baja](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-72.jpg)
Who is right? Caton normal Insall: Patella baja
![Lateral retinacular release alone in reccurent patellar dislocation Ø 21% redislocation rate (7/33 knees)¹ Lateral retinacular release alone in reccurent patellar dislocation Ø 21% redislocation rate (7/33 knees)¹](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-73.jpg)
Lateral retinacular release alone in reccurent patellar dislocation Ø 21% redislocation rate (7/33 knees)¹ Ø 35% redislocation rate (7/20 knees)² 1) Dandy and Desai, JBJS Br, 1989 2) Aglietti et al, J Orthop, 1994
![Radiographic Evaluation Ø AP Ø Preoperative Ø Lateral 45° Ø Postoperative Ø Lateral 90° Radiographic Evaluation Ø AP Ø Preoperative Ø Lateral 45° Ø Postoperative Ø Lateral 90°](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-74.jpg)
Radiographic Evaluation Ø AP Ø Preoperative Ø Lateral 45° Ø Postoperative Ø Lateral 90° Ø Intermediate follow-up Ø Merchant view (mean 3. 8 years) Ø Latest follow-up (mean 13. 8 years)
![Results Patellar Height Mean Patellar Height (Caton. Deschamps) Preop 6 m 3. 8 y Results Patellar Height Mean Patellar Height (Caton. Deschamps) Preop 6 m 3. 8 y](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-75.jpg)
Results Patellar Height Mean Patellar Height (Caton. Deschamps) Preop 6 m 3. 8 y 1. 53 0. 96 0. 97 1. 11 1. 28 0. 97 1. 06 N: 0. 6 -1. 3 Mean Patellar Height (Koshino. Sugimoto)
![Conclusion Ø The described surgical procedure is a comprehensive and effective approach to habitual Conclusion Ø The described surgical procedure is a comprehensive and effective approach to habitual](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-76.jpg)
Conclusion Ø The described surgical procedure is a comprehensive and effective approach to habitual patellar dislocation in young children
![Lateral release Lateral release](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-77.jpg)
Lateral release
![Patient preparation Patient preparation](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-78.jpg)
Patient preparation
![Physical exam (under anesthesia) Physical exam (under anesthesia)](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-79.jpg)
Physical exam (under anesthesia)
![Lateral release Lateral release](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-80.jpg)
Lateral release
![VMO advancement VMO advancement](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-81.jpg)
VMO advancement
![Wound closed Wound closed](http://slidetodoc.com/presentation_image/b816433c3c9e106bda4bbd313c0bd3c9/image-82.jpg)
Wound closed
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