Patient Information Resources


Long Island Spine Specialists, P.C.
763 Larkfield Road
2nd Floor
Commack, NY 11725
Ph: (631) 462-2225
Fax: (631) 462-2240






Child Orthopedics
General
Pain Management
Spine - Cervical
Spine - General
Spine - Lumbar
Spine - Thoracic

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What's the best way to surgically fix a chronically dislocating knee cap in someone (me) who is only 13-years-old.

Many people of all ages suffer from a condition known as recurrent patellar dislocation or patellar instability. In this condition, the patella or kneecap as it is more commonly referred to pops off to the side (usually to the lateral side away from the other knee). It may or may not pop back in place, a movement called reduction. Early on in the acute phase, treatment is likely to be conservative care with taping or bracing, and exercises. But with repeated episodes causing pain and loss of knee function, surgery may be necessary. Children and teens with this problem must be treated carefully to avoid damaging the growth plate when full growth has not been reached yet. In a recent study, the results of two surgical techniques for recurrent patellar dislocation in teenagers was compared. One method (medial retinaculum plication) or MRP is minimally invasive using an arthroscopic approach. That means instead of making a long cut to open your knee up, the surgeon inserts a tube or scope through several small holes around the knee. There is a tiny TV camera on the end of the scope that gives the surgeon an idea of what your knee looks like inside. The second surgery (vastus medialis plasty) or VMP is done with an open incision. Both of these treatment approaches are physis-sparing (they don't affect the growth plate) so there are no leg length differences after surgery. This would be very important for someone your age. Medial retinaculum plication refers to a procedure in which the medial (side closest to the other knee) retinaculum (connective tissue that holds the knee cap in the middle) is tied back using three sutures. At the same time, the lateral retinaculum on the other side of the knee (outer edge) is cut or "released" so that it can no longer pull the knee cap off center. The vastus medialis plasty is a more complex procedure. The surgeon still releases the lateral retinaculum. But instead of tying the medial retinaculum back and holding it firmly in place, the medial portion of the hamstrings and connecting joint capsule (also on the medial side) are cut, released, and moved over to the opposite side of the knee. The idea is to suture these structures in place so that they continue to exert a pull on the kneecap to keep it in the midline (middle of the knee joint). The question these surgeons wanted an answer to was this: which one of these two surgical techniques work better? They usually use the open medial vastus medialis plasty (VMP) but if the less invasive medial retinaculum plication (MRP) would work just as well, then the cosmetic appeal (no scars) might tip the scales in favor of the arthroscopic MRP approach. To compare results of these two procedures, one surgeon performed all 60 surgeries (30 teens in each treatment group). Then they followed each patient for two years at regular intervals. This type of multiple series of evaluations helps show any hidden factors that might help determine the best treatment approach for these children. CT scans were used to look at the position of the patella. The International Knee Documentation Committee (IKDC) tool was used to measure knee function. Results showed that the more invasive open surgery (vastus medialis plasty or VMP) had the better results. There were fewer re-dislocations in the group of patients who had the VMP procedure. The VMP group also had better clinical outcomes. And in the end, the VMP group had better overall results despite the fact that patients in both groups experienced deterioration of knee stability over time. They concluded that the more invasive procedure (VMP) is also a more reliable way to treat chronically recurrent patellar (knee cap) dislocations. The medial soft tissue structures just weren't strong enough to counteract the lateral pull on the knee cap. Even so, there was a high rate of recurrence in both groups. You'll want to be seen by a physician if you haven't already. All treatment options (conservative or nonoperative care as well as surgical intervention) should be explained and explored. It's possible you only need something as simple as activity modification and/or restriction or perhaps an exercise program. Surgery should always be the last option considered.

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